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Cost-effectiveness of same-admission versus interval cholecystectomy after mild gallstone pancreatitis in the PONCHO trial.
- Source :
-
The British journal of surgery [Br J Surg] 2016 Nov; Vol. 103 (12), pp. 1695-1703. Date of Electronic Publication: 2016 Aug 12. - Publication Year :
- 2016
-
Abstract
- Background: Same-admission cholecystectomy is indicated after gallstone pancreatitis to reduce the risk of recurrent disease or other gallstone-related complications, but its impact on overall costs is unclear. This study analysed the cost-effectiveness of same-admission versus interval cholecystectomy after mild gallstone pancreatitis.<br />Methods: In a multicentre RCT (Pancreatitis of biliary Origin: optimal timiNg of CHOlecystectomy; PONCHO) patients with mild gallstone pancreatitis were randomized before discharge to either cholecystectomy within 72 h (same-admission cholecystectomy) or cholecystectomy after 25-30 days (interval cholecystectomy). Healthcare use of all patients was recorded prospectively using clinical report forms. Unit costs of resources used were determined, and patients completed multiple Health and Labour Questionnaires to record pancreatitis-related absence from work. Cost-effectiveness analyses were performed from societal and healthcare perspectives, with the costs per readmission prevented as primary outcome with a time horizon of 6 months.<br />Results: All 264 trial participants were included in the present analysis, 128 randomized to same-admission cholecystectomy and 136 to interval cholecystectomy. Same-admission cholecystectomy reduced the risk of acute readmission for recurrent gallstone-related complications from 16·9 to 4·7 per cent (P = 0·002). Mean total costs from a societal perspective were €234 (95 per cent c.i. -1249 to 738) less per patient in the same-admission cholecystectomy group. Same-admission cholecystectomy was superior to interval cholecystectomy, with a societal incremental cost-effectiveness ratio of -€1918 to prevent one readmission for gallstone-related complications.<br />Conclusion: In mild biliary pancreatitis, same-admission cholecystectomy was more effective and less costly than interval cholecystectomy.<br /> (© 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.)
- Subjects :
- Acute Disease
Adult
Aged
Cost-Benefit Analysis
Female
Gallstones complications
Gallstones surgery
Health Care Costs
Humans
Length of Stay economics
Length of Stay statistics & numerical data
Male
Middle Aged
Pancreatitis complications
Pancreatitis surgery
Patient Admission economics
Surveys and Questionnaires
Treatment Outcome
Cholecystectomy economics
Gallstones economics
Pancreatitis economics
Subjects
Details
- Language :
- English
- ISSN :
- 1365-2168
- Volume :
- 103
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- The British journal of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 27517163
- Full Text :
- https://doi.org/10.1002/bjs.10222