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

Introduction: The optimum timing of cholecystectomy for patients admitted with acute gallbladder pathology is unclear. Some studies have shown that emergency cholecystectomy, performed during index admission can reduce length of stay with similar rates of conversion to open surgery, complications, and mortality compared to a ‘delayed’ operation following discharge, while others have described that cholecystectomy performed during the index acute admission results in higher morbidity, extended length of stay, and increasing costs. This study examines 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 (£4,570 vs. £4,720) and more effective (0.8868 vs. 0.8662 QALYs) than delayed cholecystectomy. Probabilistic sensitivity analysis showed that the emergency strategy is more than 60% likely to be cost-effective across willingness to pay values for the QALY from £0 to £100,000. Discussion: This analysis demonstrates that 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 the health care provider due to the reduced costs.