Cost-effectiveness of emergency versus delayed laparoscopic cholecystectomy for acute gallbladder pathology

Author:

Sutton A J12ORCID,Vohra R S3,Hollyman M4ORCID,Marriott P J45,Buja A6,Alderson D7,Pasquali S8ORCID,Griffiths E A5,Vohra R S9,Spreadborough P9,Marriott P J9,Kirkham A9,Alderson D9,Griffiths E A9,Fenwick S10,Elmasry M10,Nunes Q M10,Kennedy D,Khan R B11,Khan M A S11,Magee C J12,Jones S M12,Mason D12,Parappally C P12,Mathur P13,Saunders M13,Jamel S13,Ul Haque S13,Zafar S13,Shiwani M H14,Samuel N14,Dar F14,Jackson A14,Lovett B15,Dindyal S15,Winter H15,Fletcher T15,Rahman S15,Wheatley K16,Nieto T16,Ayaani S16,Youssef H17,Nijjar R S17,Watkin H17,Naumann D17,Emesih S17,Sarmah P B17,Lee K17,Joji N17,Heath J18,Teasdale R L18,Weerasinghe C18,Needham P J19,Welbourn H19,Forster L19,Finch D19,Blazeby J M20,Robb W20,McNair A G K20,Hrycaiczuk A20,Charalabopoulos A21,Kadirkamanathan S21,Tang C-B21,Jayanthi N V G21,Noor N21,Dobbins B22,Cockbain A J22,Nilsen-Nunn A22,de Siqueira J22,Pellen M23,Cowley J B23,Ho W-M23,Miu V23,White T J24,Hodgkins K A24,Kinghorn A24,Tutton M G25,Al-Abed Y A25,Menzies D25,Ahmad A25,Reed J25,Khan S25,Monk D26,Vitone L J26,Murtaza G26,Joel A26,Brennan S27,Shier D27,Zhang C27,Yoganathan T27,Robinson S J28,McCallum I J D28,Jones M J28,Elsayed M28,Tuck E28,Wayman J28,Carney K28,Aroori S29,Hosie K B29,Kimble A29,Bunting D M29,Fawole A S30,Basheer M30,Dave R V30,Sarveswaran J30,Jones E30,Kendal C30,Tilston M P31,Gough M31,Wallace T31,Singh S31,Downing J31,Mockford K A31,Issa E31,Shah N31,Chauhan N31,Wilson T R32,Forouzanfar A32,Wild J R L32,Nofal E32,Bunnell C32,Madbak K32,Rao S T V33,Devoto L33,Siddiqi N33,Khawaja Z33,Hewes J C34,Gould L34,Chambers A34,Rodriguez D U34,Sen G35,Robinson S35,Carney K35,Bartlett F35,Rae D M36,Stevenson T E J36,Sarvananthan K36,Dwerryhouse S J37,Higgs S M37,Old O J37,Hardy T J37,Shah R37,Hornby S T37,Keogh K37,Frank L37,Al-Akash M38,Upchurch E A38,Frame R J39,Hughes M39,Jelley C39,Weaver S40,Roy S40,Sillo T O40,Galanopoulos G40,Cuming T41,Cunha P41,Tayeh S41,Kaptanis S41,Heshaishi M42,Eisawi A42,Abayomi M42,Ngu W S42,Fleming K42,Bajwa D S42,Chitre V43,Aryal K43,Ferris P43,Silva M44,Lammy S44,Mohamed S44,Khawaja A44,Hussain A44,Ghazanfar M A44,Bellini M I44,Ebdewi H45,Elshaer M45,Gravante G45,Drake B45,Ogedegbe A46,Mukherjee D46,Arhi C46,Iqbal L G N46,Watson N F47,Aggarwal S K47,Orchard P47,Villatoro E47,Willson P D48,Mok J48,Woodman T48,Deguara J48,Garcea G49,Babu B I49,Dennison A R49,Malde D49,Lloyd D49,Satheesan S49,Al-Taan O49,Boddy A49,Slavin J P50,Jones R P50,Ballance L50,Gerakopoulos S50,Jambulingam P51,Mansour S51,Sakai N51,Acharya V51,Sadat M M52,Karim L52,Larkin D52,Amin K52,Khan A53,Law J53,Jamdar S53,Smith S R53,Sampat K53,O'shea K M53,Manu M54,Asprou F M54,Malik N S54,Chang J54,Johnstone M54,Lewis M55,Roberts G P55,Karavadra B55,Photi E55,Hewes J34,Gould L34,Chambers A34,Rodriguez D34,O'Reilly D A56,Rate A J56,Sekhar H56,Henderson L T56,Starmer B Z56,Coe P O56,Tolofari S56,Barrie J56,Bashir G57,Sloane J57,Madanipour S57,Halkias C57,Trevatt A E J57,Borowski D W58,Hornsby J58,Courtney M J58,Virupaksha S58,Seymour K59,Robinson S59,Hawkins H59,Bawa S59,Gallagher P V59,Reid A59,Wood P59,Finch J G60,Parmar J60,Stirland E60,Gardner-Thorpe J61,Al-Muhktar A61,Peterson M61,Majeed A61,Bajwa F M62,Martin J62,Choy A62,Tsang A62,Pore N63,Andrew D R63,Al-Khyatt W63,Taylor C63,Bhandari S63,Chambers A63,Subramanium D63,Toh S K C64,Carter N C64,Tate S64,Pearce B64,Wainwright D64,Mercer S J64,Knight B64,Vijay V65,Alagaratnam S65,Sinha S65,Khan S65,El-Hasani S S66,Hussain A A66,Bhattacharya V67,Kansal N67,Fasih T67,Jackson C67,Siddiqui M N68,Chishti I A68,Fordham I J68,Siddiqui Z68,Bausbacher H69,Geogloma I69,Gurung K69,Tsavellas G70,Basynat P70,Shrestha A K70,Basu S70,Mohan A C70,Harilingam M70,Rabie M70,Akhtar M70,Kumar P71,Jafferbhoy S F71,Hussain N71,Raza S71,Haque M72,Alam I72,Aseem R72,Patel S72,Asad M72,Booth M I73,Ball W R73,Wood C P J73,Pinho-Gomes A C73,Kausar A74,Obeidallah M R74,Varghase J75,Lodhia J75,Bradley D75,Rengifo C75,Lindsay D75,Gopalswamy S76,Finlay I76,Wardle S76,Bullen N76,Iftikhar S Y77,Awan A77,Ahmed J77,Leeder P77,Fusai G78,Bond-Smith G78,Psica A78,Puri Y78,Hou D79,Noble F79,Szentpali K79,Broadhurst J79,Date R80,Hossack M R80,Goh Y L80,Turner P80,Shetty V80,Riera M81,Macano C A W81,Sukha A81,Preston S R82,Hoban J R82,Puntis D J82,Williams S V82,Krysztopik R83,Kynaston J83,Batt J83,Doe M83,Goscimski A84,Jones G H84,Smith S R84,Hall C84,Carty N85,Ahmed J85,Panteleimonitis S85,Gunasekera R T86,Sheel A R G86,Lennon H86,Hindley C86,Reddy M87,Kenny R87,Elkheir N87,McGlone E R87,Rajaganeshan R88,Hancorn K88,Hargreaves A88,Prasad R89,Longbotham D A89,Vijayanand D89,Wijetunga I89,Ziprin P90,Nicolay C R90,Yeldham G90,Read E90,Gossage J A91,Rolph R C91,Ebied H91,Phull M91,Khan M A92,Popplewell M92,Kyriakidis D92,Hussain A92,Henley N93,Packer J R93,Derbyshire L93,Porter J93,Appleton S94,Farouk M94,Basra M94,Jennings N A95,Ali S95,Kanakala V95,Ali H96,Lane R96,Dickson-Lowe R96,Zarsadias P96,Mirza D97,Puig S97,Al Amari K97,Vijayan D97,Sutcliffe R97,Marudanayagam R97,Hamady Z98,Prasad A R98,Patel A98,Durkin D99,Kaur P99,Bowen L99,Byrne J P100,Pearson K L100,Delisle T G100,Davies J100,Tomlinson M A101,Johnpulle M A101,Slawinski C101,Macdonald A102,Nicholson J102,Newton K102,Mbuvi J102,Farooq A103,Mothe B S103,Zafrani Z103,Brett D103,Francombe J104,Spreadborough P104,Barnes J104,Cheung M104,Al-Bahrani A Z105,Preziosi G105,Urbonas T105,Alberts J106,Mallik M106,Patel K106,Segaran A106,Doulias T106,Sufi P A107,Yao C107,Pollock S107,Manzelli A108,Wajed S108,Kourkulos M108,Pezzuto R108,Wadley M109,Hamilton E109,Jaunoo S109,Padwick R109,Sayegh M110,Newton R C110,Hebbar M110,Farag S F110,Spearman J111,Hamdan M F111,D'Costa C111,Blane C111,Giles M112,Peter M B112,Hirst N A112,Hossain T112,Pannu A112,El-Dhuwaib Y112,Morrison T E M112,Taylor G W112,Thompson R L E113,McCune K113,Loughlin P113,Lawther R113,Byrnes C K114,Simpson D J114,Mawhinney A114,Warren C114,McKay D115,McIlmunn C115,Martin S115,MacArtney M115,Diamond T116,Davey P116,Jones C116,Clements J M116,Digney R116,Chan W M116,McCain S116,Gull S116,Janeczko A116,Dorrian E116,Harris A116,Dawson S116,Johnston D116,McAree B116,Ghareeb E117,Thomas G117,Connelly M117,McKenzie S117,Cieplucha K117,Spence G118,Campbell W118,Hooks G118,Bradley N118,Hill A D K119,Cassidy J T119,Boland M119,Burke P120,Nally D M120,Hill A D K121,Khogali E121,Shabo W121,Iskandar E121,McEntee G P122,O'Neill M A122,Peirce C122,Lyons E M122,O'Sullivan A W123,Thakkar R123,Carroll P123,Ivanovski I123,Balfe P124,Lee M124,Winter D C125,Kelly M E125,Hoti E125,Maguire D125,Karunakaran P125,Geoghegan J G125,McDermott F125,Martin S T125,Cross K S126,Cooke F126,Zeeshan S126,Murphy J O126,Mealy K127,Mohan H M127,Nedujchelyn Y127,Ullah M F127,Ahmed I128,Giovinazzo F128,Milburn J128,Prince S129,Brooke E129,Buchan J129,Khalil A M130,Vaughan E M130,Ramage M I130,Aldridge R C130,Gibson S131,Nicholson G A131,Vass D G131,Grant A J132,Holroyd D J132,Jones M A132,Sutton C M L R132,O'Dwyer P133,Nilsson F133,Weber B134,Williamson T K134,Lalla K134,Bryant A134,Carter C R135,Forrest C R135,Hunter D I135,Nassar A H136,Orizu M N136,Knight K136,Qandeel H136,Suttie S137,Belding R137,McClarey A137,Boyd A T138,Guthrie G J K138,Lim P J138,Luhmann A138,Watson A J M139,Richards C H139,Nicol L139,Madurska M139,Harrison E140,Boyce K M140,Roebuck A140,Ferguson G140,Pati P141,Wilson M S J141,Dalgaty F141,Fothergill L141,Driscoll P J142,Mozolowski K L142,Banwell V142,Bennett S P142,Rogers P N143,Skelly B L143,Rutherford C L143,Mirza A K143,Lazim T144,Lim H C C144,Duke D144,Ahmed T144,Beasley W D145,Wilkinson M D145,Maharaj G145,Malcolm C145,Brown T H146,Shingler G M146,Mowbray N146,Radwan R146,Morcous P147,Wood S147,Kadhim A147,Stewart D J148,Baker A L148,Tanner N148,Shenoy H148,Hafiz S149,De Marchi J A149,Singh-Ranger D149,Hisham E149,Ainley P149,O'Neill S149,Terrace J149,Napetti S149,Hopwood B149,Rhys T149,Downing J149,Kanavati O149,Coats M149,Aleksandrov D149,Kallaway C149,Yahya S149,Weber B149,Templeton A149,Trotter M149,Lo C149,Dhillon A149,Heywood N149,Aawsaj Y149,Hamdan A149,Reece-Bolton O149,McGuigan A149,Shahin Y149,Ali A149,Luther A149,Nicholson J A149,Rajendran I149,Boal M149,Ritchie J149

Affiliation:

1. Health Economics Unit, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK

2. National Institute for Health Research Diagnostic Evidence Co-operative Leeds, Leeds, UK

3. Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK

4. West Midlands Surgical Research Collaborative, Birmingham, UK

5. Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK

6. Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua

7. Academic Department of Surgery, University of Birmingham, Birmingham, UK

8. Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy

9. WestMidlands Surgical Research Collaborative, University of Birmingham CholeS study data collectors are as follows, England

10. Aintree University Hospital NHS Foundation Trust

11. Airedale General Hospital

12. Wirral University Teaching Hospital

13. Barnet and Chase Farm Hospital

14. Barnsley District General Hospital

15. Basildon University Hospital

16. Sandwell and West Birmingham Hospitals NHS Trust

17. Heart of England Foundation NHS Trust

18. Blackpool Teaching Hospitals NHS Foundation Trust

19. Bradford Teaching Hospitals NHS Foundation Trust

20. University Hospitals Bristol NHS Trust

21. Broomfield Hospital

22. Calderdale and Huddersfield NHS Trust

23. Hull and East Yorkshire NHS Trust

24. Chesterfield Royal Hospital NHS Foundation Trust

25. Colchester Hospital University NHS Foundation Trust

26. Countess of Chester NHS Foundation Trust

27. Croydon Health Services NHS Trust

28. North Cumbria University Hospitals Trust

29. PlymouthHospitals NHS Trust

30. Mid Yorkshire NHS Trust

31. Northern Lincolnshire and Goole NHS Foundation Trust

32. Doncaster and Bassetlaw Hospitals NHS Foundation Trust

33. Dorset County Hospital NHS Foundation Trust

34. North Bristol NHS Trust

35. Freeman Hospital

36. Frimley Park Hospital NHS Trust

37. Gloucestershire Hospitals NHS Trust

38. Great Western Hospitals NHS Foundation Trust

39. Harrogate and District NHS Foundation Trust

40. Wye Valley NHS Trust

41. Homerton University Hospital NHS Trust

42. Tees Hospitals NHS Foundation Trust

43. Paget University Hospitals NHS Foundation Trust

44. Oxford University NHS Trust

45. Kettering General Hospital NHS Foundation Trust

46. Barking, Havering and Redbridge University Hospitals NHS Trust

47. King's Mill Hospital

48. Kingston Hospital NHS Foundation Trust

49. University Hospitals of Leicester NHS Trust

50. Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust

51. Luton and Dunstable University Hospital NHS Foundation Trust

52. Macclesfield District General Hospital

53. Central Manchester NHS Foundation Trust

54. Royal Wolverhampton Hospitals NHS Trust

55. Norfolk and Norwich University Hospitals NHS Foundation Trust

56. Pennine Acute NHS Trust

57. North Middlesex Trust

58. North Tees and Hartlepool NHS Foundation Trust

59. Northumbria Healthcare NHS Foundation Trust

60. Northampton General Hospital NHS Trust

61. Sheffield Teaching Hospitals NHS Foundation Trust

62. Peterborough City Hospital

63. United Lincolnshire Hospitals NHS Trust

64. Portsmouth Hospitals NHS Trust)

65. Princess Alexandra Hospital NHS Trust

66. King's College Hospital NHS Foundation Trust

67. Gateshead Health NHS Foundation Trust

68. Lewisham and Greenwich NHS Trust

69. Queen Elizabeth Hospital NHS Trust

70. East Kent Hospitals University NHS Foundation Trust

71. Burton Hospitals NHS Foundation Trust

72. Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Trust

73. Royal Berkshire NHS Foundation Trust

74. East Lancashire Hospital Trust

75. Royal Bolton Hospital NHS Foundation Trust

76. Royal Cornwall NHS Trust

77. Royal Derby NHS Foundation Trust

78. Royal Free, London

79. Hampshire Hospitals NHS Foundation Trust

80. Lancashire Teaching Hospitals NHS Foundation Trust

81. Royal Shrewsbury Hospital

82. Royal Surrey County Hospital NHS Foundation Trust

83. Royal United Hospitals Bath NHS Foundation Trust

84. Salford Royal NHS Foundation Trust

85. Salisbury Hospital Foundation Trust

86. Southport and Ormskirk Hospital NHS Trust

87. St George's Healthcare NHS Trust

88. St Helens and Knowsley Teaching Hospitals NHS Trust

89. Leeds Teaching Hospitals

90. Imperial College Healthcare NHS Trust

91. St Thomas’ Hospital, London

92. Mid Staffordshire NHS Foundation Trust

93. Stockport NHS Foundation Trust

94. Bucks Healthcare NHS Trust

95. City Hospitals Sunderland NHS Foundation Trust

96. Tunbridge Wells and Maidstone NHS Trust

97. University Hospital Birmingham NHS Foundation Trust

98. University Hospital Coventry and Warwickshire NHS Trust

99. University Hospital of North Staffordshire NHS Trust

100. University Hospital Southampton NHS Foundation Trust

101. University Hospitals of Morecambe Bay NHS Foundation Trust

102. University Hospital South Manchester NHS Foundation Trust

103. Warrington and Halton Hospitals NHS Trust

104. South Warwickshire NHS Foundation Trust

105. Watford General Hospital

106. West Suffolk NHS Trust

107. Whittington NHS Trust

108. Wonford Hospital

109. Worcestershire Acute Hospitals NHS Trust

110. Western Sussex Hospitals NHS Foundation Trust

111. Yeovil District Hospital NHS Trust

112. York Teaching Hospital NHS Foundation Trust, Northern, Ireland

113. Altnagelvin Area Hospital

114. Antrim Area Hospital

115. Daisy Hill Hospital

116. Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital

117. South West Acute Hospital

118. Ulster Hospital, Republic of Ireland

119. Beaumont Hospital, Dublin

120. University Hospital Limerick

121. Louth County Hospital and Our Lady of Lourdes Hospital

122. Mater Hospital, Dublin

123. Mercy University Hospital

124. St Luke's General Hospital Kilkenny

125. St Vincent's University and Private Hospitals, Dublin

126. Waterford Regional Hospital

127. Wexford General Hospital, Scotland

128. Aberdeen Royal Infirmary

129. Belford Hospital

130. Borders General Hospital

131. Crosshouse Hospital, Ayrshire and Arran

132. Dr Gray's Hospital

133. Gartnavel General Hospital

134. Gilbert Bain Hospital

135. Glasgow Royal Infirmary

136. Monklands Hospital

137. Ninewells Hospital

138. Perth Royal Infirmary

139. Raigmore Hospital

140. Royal Infirmary of Edinburgh

141. Stracathro Hospital

142. Victoria Hospital, Kirkcaldy

143. Western Infirmary, Glasgow, Wales

144. Bronglais General Hospital

145. Glangwili General and Prince Philip Hospital

146. Morriston and Singleton Hospitals

147. Princess of Wales Hospital

148. Wrexham Maelor Hospital

149. Data validators

Abstract

Abstract Background The optimal timing of cholecystectomy for patients admitted with acute gallbladder pathology is unclear. Some studies have shown that emergency cholecystectomy during the index admission can reduce length of hospital stay with similar rates of conversion to open surgery, complications and mortality compared with a ‘delayed’ operation following discharge. Others have reported that cholecystectomy during the index acute admission results in higher morbidity, extended length of stay and increased costs. This study examined the cost-effectiveness of emergency versus delayed cholecystectomy for acute benign gallbladder disease. Methods Using data from a prospective population-based cohort study examining the outcomes of cholecystectomy in the UK and Ireland, a model-based cost–utility analysis was conducted from the perspective of the UK National Health Service, with a 1-year time horizon for costs and outcomes. Probabilistic sensitivity analysis was used to investigate the impact of parameter uncertainty on the results obtained from the model. Results Emergency cholecystectomy was found to be less costly (£4570 versus £4720; €5484 versus €5664) and more effective (0·8868 versus 0·8662 QALYs) than delayed cholecystectomy. Probabilistic sensitivity analysis showed that the emergency strategy is more than 60 per cent likely to be cost-effective across willingness-to-pay values for the QALY from £0 to £100 000 (€0–120 000). Conclusion Emergency cholecystectomy is less costly and more effective than delayed cholecystectomy. This approach is likely to be beneficial to patients in terms of improved health outcomes and to the healthcare provider owing to the reduced costs.

Publisher

Oxford University Press (OUP)

Subject

Surgery

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