D W da Costa1, L M Dijksman2, S A Bouwense3, N J Schepers4, M G Besselink5, H C van Santvoort6, D Boerma6, H G Gooszen3, M G W Dijkgraaf7. 1. Department of Radiology, St Antonius Hospital, Nieuwegein, The Netherlands. d.dacosta@pancreatitis.nl. 2. Department of Epidemiology and Statistics, Onze Lieve Vrouwe Gasthuis, Academic Medical Centre, Amsterdam, The Netherlands. 3. Department of Operating Theatres and Evidence Based Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands. 4. Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands. 5. Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands. 6. Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands. 7. Clinical Research Unit, Academic Medical Centre, Amsterdam, The Netherlands.
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. 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. 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. CONCLUSION: In mild biliary pancreatitis, same-admission cholecystectomy was more effective and less costly than interval cholecystectomy.
RCT Entities:
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. 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. 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. CONCLUSION: In mild biliary pancreatitis, same-admission cholecystectomy was more effective and less costly than interval cholecystectomy.
Authors: Somashekar G Krishna; Andrew J Kruger; Nishi Patel; Alice Hinton; Dhiraj Yadav; Darwin L Conwell Journal: Pancreas Date: 2018-09 Impact factor: 3.327
Authors: Pablo Giuffrida; David Biagiola; Agustín Cristiano; Victoria Ardiles; Martín de Santibañes; Rodrigo Sanchez Clariá; Juan Pekolj; Eduardo de Santibañes; Oscar Mazza Journal: Updates Surg Date: 2020-02-03