TY - JOUR
T1 - Cost-effectiveness of Restrictive Strategy Versus Usual Care for Cholecystectomy in Patients with Gallstones and Abdominal Pain (SECURE-trial)
AU - Latenstein, Carmen S. S.
AU - Wennmacker, Sarah Z.
AU - van Dijk, Aafke H.
AU - Drenth, Joost P. H.
AU - Westert, Gert P.
AU - van Laarhoven, Cornelis J. H. M.
AU - Boermeester, Marja A.
AU - de Reuver, Philip R.
AU - Dijkgraaf, Marcel G. W.
N1 - Funding Information: Funding was provided by The Netherlands Organization for Health Research and Development, and CZ healthcare insurance. Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Objective: To perform a cost-effectiveness analysis of restrictive strategy versus usual care in patients with gallstones and abdominal pain. Summary of Background Data: A restrictive selection strategy for surgery in patients with gallstones reduces cholecystectomies, but the impact on overall costs and cost-effectiveness is unknown. Methods: Data of a multicentre, randomized-controlled trial (SECURE-trial) were used. Adult patients with gallstones and abdominal pain were included. Restrictive strategy was economically evaluated against usual care from a societal perspective. Hospital-use of resources was gathered with case-report forms and out-of-hospital consultations, out-of-pocket expenses, and productivity loss were collected with questionnaires. National unit costing was applied. The primary outcome was the cost per pain-free patient after 12 months. Results: All 1067 randomized patients (49.0 years, 73.7% females) were included. After 12 months, 56.2% of patients were pain-free in restrictive strategy versus 59.8% after usual care. The restrictive strategy significantly reduced the cholecystectomy rate with 7.7% and reduced surgical costs with €160 per patient, €162 was saved from a societal perspective. The cost-effectiveness plane showed that restrictive strategy was cost saving in 89.1%, but resulted in less pain-free patients in 88.5%. Overall, the restrictive strategy saved €4563 from a societal perspective per pain-free patient lost. Conclusions: A restrictive selection strategy for cholecystectomy saves €162 compared to usual care, but results in fewer pain-free patients. The incremental cost per pain-free patient are savings of €4563 per pain-free patient lost. The higher societal willingness to pay for 1 extra pain-free patient, the lower the probability that the restrictive strategy will be cost-effective. Trial registration: The Netherlands National Trial Register NTR4022. Registered on 5 June 2013.
AB - Objective: To perform a cost-effectiveness analysis of restrictive strategy versus usual care in patients with gallstones and abdominal pain. Summary of Background Data: A restrictive selection strategy for surgery in patients with gallstones reduces cholecystectomies, but the impact on overall costs and cost-effectiveness is unknown. Methods: Data of a multicentre, randomized-controlled trial (SECURE-trial) were used. Adult patients with gallstones and abdominal pain were included. Restrictive strategy was economically evaluated against usual care from a societal perspective. Hospital-use of resources was gathered with case-report forms and out-of-hospital consultations, out-of-pocket expenses, and productivity loss were collected with questionnaires. National unit costing was applied. The primary outcome was the cost per pain-free patient after 12 months. Results: All 1067 randomized patients (49.0 years, 73.7% females) were included. After 12 months, 56.2% of patients were pain-free in restrictive strategy versus 59.8% after usual care. The restrictive strategy significantly reduced the cholecystectomy rate with 7.7% and reduced surgical costs with €160 per patient, €162 was saved from a societal perspective. The cost-effectiveness plane showed that restrictive strategy was cost saving in 89.1%, but resulted in less pain-free patients in 88.5%. Overall, the restrictive strategy saved €4563 from a societal perspective per pain-free patient lost. Conclusions: A restrictive selection strategy for cholecystectomy saves €162 compared to usual care, but results in fewer pain-free patients. The incremental cost per pain-free patient are savings of €4563 per pain-free patient lost. The higher societal willingness to pay for 1 extra pain-free patient, the lower the probability that the restrictive strategy will be cost-effective. Trial registration: The Netherlands National Trial Register NTR4022. Registered on 5 June 2013.
KW - cholecystolithiasis
KW - cost-effectiveness analysis
KW - incremental cost-effectiveness ratio
KW - randomized controlled trial
UR - http://www.scopus.com/inward/record.url?scp=85134399638&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/SLA.0000000000004532
DO - https://doi.org/10.1097/SLA.0000000000004532
M3 - Article
C2 - 33065642
SN - 0003-4932
VL - 276
SP - E93-E101
JO - Annals of surgery
JF - Annals of surgery
IS - 2
ER -