Cost-effectiveness of cholecystectomy compared to conservative management in people presenting with uncomplicated symptomatic gallstones or cholecystitis in India

ABSTRACT

Objectives

Gallstone diseases impose a significant economic burden on the health care system; thus, determining cost-effective management for gallstones is essential. We aim to estimate the cost-effectiveness of cholecystectomy compared with conservative management in individuals with uncomplicated symptomatic gallstones or cholecystitis in India.

Methods

A decision-analytic Markov model was used to compare the costs and QALY of early laparoscopic cholecystectomy (ELC), delayed laparoscopic cholecystectomy (DLC), and conservative management (CM) in patients with symptomatic uncomplicated gallstone/cholecystitis from an Indian health system perspective. Incremental cost-effectiveness ratio (ICER) was calculated. One-way and probabilistic sensitivity analyses were performed to test parameter uncertainties.

Results

ELC and DLC, compared to CM, incurred an incremental cost of -₹10,948 ($146) and ₹1,054 ($14) for the 0.032 QALYs gained. The ICER was -₹3,42,758 ($4577) for ELC vs. CM, and ₹33,183 ($443) for DLC vs. CM, suggesting ELC and DLC are cost-effective. ELC saved ₹12,001 ($160) for 0.0002 QALYs gained compared to DLC, resulting in an ICER of -₹6,43,89,441 ($8,59,733). The results were robust to changes in the input parameters in sensitivity analyses.

Conclusion

ELC is dominant compared to both DLC and CM, and DLC is more cost-effective than CM. Thus, ELC may be preferable to other gallstone disease managements.

KEYWORDS:

• Cholecystectomy
• cholecystitis
• cholelithiasis
• conservative management
• cost-effectiveness
• economic evaluation

Article highlights

• Early removal of the gallbladder by surgery following the gallstone-related symptoms is more effective in providing pain relief and a better quality of life than the conservative management with painkillers and antibiotics

• Similarly, for gallbladder removal, early surgery is better than delayed surgery since it results in fewer surgical complications and marginally higher quality of life

• Early gallbladder removal surgery offers the best value for money (cost-effective) compared to conservative management or delayed surgery.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Authors contributions

B Bagepally: Conceptualization, Data curation, Formal analysis, inputs on original draft Investigation, Methodology, Software, review & editing. M Haridoss: Conceptualization, Data curation, Methodology, Formal analysis, Original draft. S Kumar: Data curation, review & editing. N Meenakumar: Data curation, review & editing. A Sasidharan: Data curation, review & editing. K Rajsekar: Expert suggestions, review & editing. N Oswal: Expert suggestions, review & editing. All authors read and approved the final version of the manuscript for publication.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2023.2160706

Additional information

Funding

This research received no specific grant from any funding agency, commercial or not-for-profit sectors. However, ICMR-NIE HTA Resource Centre is supported by Dept. of Health Research, Govt. of India. Funding agency had no role in the study.