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Related Experiment Videos

Optimizing choledocholithiasis management: a cost-effectiveness analysis.

Benjamin K Poulose1, Ted Speroff, Michael D Holzman

  • 1Section of Surgical Sciences,Vanderbilt University School of Medicine, 1161 21st Avenue, Nashville, TN 37232, USA. benjamin.poulose@vanderbilt.edu

Archives of Surgery (Chicago, Ill. : 1960)
|January 17, 2007
PubMed
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Endoscopic retrograde cholangiopancreatography (ERCP) is more cost-effective and effective for managing choledocholithiasis (CDL) after laparoscopic cholecystectomy than laparoscopic common bile duct exploration (LCBDE). ERCP offers better outcomes at a lower cost.

Area of Science:

  • Gastroenterology
  • Surgical Outcomes
  • Health Economics

Background:

  • Incidental choledocholithiasis (CDL) is often discovered during laparoscopic cholecystectomy with intraoperative cholangiogram (LC/IOC).
  • Management options for incidental CDL include endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE).

Purpose of the Study:

  • To compare the cost-effectiveness of ERCP versus LCBDE for managing incidental CDL following LC/IOC.
  • To identify key factors influencing the cost-effectiveness of these treatment strategies.

Main Methods:

  • A cost-effectiveness analysis was conducted from an institutional perspective.
  • The study compared ERCP (performed after LC/IOC) with LCBDE (performed during LC/IOC).
  • Sensitivity analyses were performed to assess the impact of various cost parameters.

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Main Results:

  • ERCP was found to be the optimal treatment, with a base case cost of $24,300 for 0.9 quality-adjusted life years (QALYs) gained, compared to LCBDE at $28,400 for 0.88 QALYs.
  • ERCP remained the preferred strategy in probabilistic sensitivity analyses.
  • LCBDE became preferred only if the cost of a lost operative case was $3,100 or less and ERCP hospitalization costs were $18,000 or more.

Conclusions:

  • ERCP is both less costly and more effective than LCBDE for managing incidental CDL.
  • Key decision-making factors include the cost of a potential lost case with LCBDE and ERCP hospitalization expenses.