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

Scholarcy highlights

  • 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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