Cost-Effectiveness of Elective Laparoscopic Cholecystectomy Versus Observation in Older Patients Presenting with Mild Biliary Disease

We developed a decision model for the initial treatment

Abhishek D. Parmar

2014

Our objective was to determine the probability threshold for recurrent symptoms at which elective cholecystectomy compared to observation in older patients with symptomatic cholelithiasis is the more effective and cost-effective option
We performed a threshold analysis in order to determine the probability of symptoms at which elective cholecystectomy became more effective and more cost-effective
For older patients presenting with mild biliary disease, if the likelihood for continuing symptoms is greater than 45%, early elective cholecystectomy is the more effective treatment option at an incremental cost of $2,191
In a previous study evaluating the natural history of older patients with untreated symptomatic cholelithiasis we derived a prognostic nomogram which reliably identified approximately 10% of older patients with incident symptomatic gallstones who had over a >40% 2-year risk of developing gallstone-related complications and an additional 50% of patients with less than 10% 2-year risk
Our findings suggest that older patients with mild biliary disease benefit from early elective cholecystectomy when there is a high suspicion for recurrent illness
These data can be used to guide shared decision-making in older patients presenting with symptomatic cholelithiasis
This data driven, patient-centered approach has the potential to streamline the decision-making process for individual older adults while improving outcomes at the population level for all

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