Faculty Collaboration Database

Cost effectiveness of routine laparoscopic ultrasound for assessment of resectability of gallbladder cancer. Ann Surg Oncol 2014 Jul;21(7):2413-9

Date

03/05/2014

Pubmed ID

24590431

DOI

10.1245/s10434-014-3487-y

Scopus ID

2-s2.0-84902157458 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

BACKGROUND: In addition to a diagnostic laparoscopy (DL), a routine laparoscopic ultrasound (LUS) has been proposed to identify undetected hepatic metastases and/or anatomically advanced disease in patients with T2 or higher gall bladder cancer (GBC) patients planned for surgical resection. It was hypothesized that a routine LUS is not a cost-effective strategy for these patients.

METHODS: Decision tree modeling was undertaken to compare DL-LUS vs. DL at the time of definitive resection of GBC (with no prior cholecystectomy). Costs in US dollars (payer's perspective), quality-adjusted life weeks (QALWs), and incremental cost-effectiveness ratios (ICER) were calculated (horizon: 6 weeks, willingness-to-pay: $1,000/QALW or $50,000/QALY).

RESULTS: DL-LUS was cost effective at the base case scenario (costs: $30,838 for DL vs. $30,791 for DL-LUS and effectiveness 3.81 QALWs DL vs. 3.82 QALW DL-LUS), resulting in a cost reduction of $9,220 per quality-adjusted life week gained (or $479,469 per QALY). DL-LUS became less cost effective as the cost of ultrasound increased or the probability of exclusion from resection decreased.

CONCLUSIONS: Routine LUS with DL for the assessment of resectability and exclusion of metastases is cost effective for patients with GBC. Until improvements in preoperative imaging occur to decrease the probability of exclusion, this appears to be a feasible strategy.

Author List

Nadeem H, Jayakrishnan TT, Groeschl RT, Zacharias A, Clark Gamblin T, Turaga KK

MESH terms used to index this publication - Major topics in bold

Anatomy, Cross-Sectional
Cost-Benefit Analysis
Decision Support Techniques
Follow-Up Studies
Gallbladder Neoplasms
Humans
Laparoscopy
Markov Chains
Preoperative Care
Prognosis
Quality of Life
Ultrasonography