Cost-effective treatment of patients with symptomatic cholelithiasis and possible common bile duct stones

Lisa M. Brown, Stanley J. Rogers, John P. Cello, Karen Brasel, John M. Inadomi

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background: Clinicians must choose a treatment strategy for patients with symptomatic cholelithiasis without knowing whether common bile duct (CBD) stones are present. The purpose of this study was to determine the most cost-effective treatment strategy for patients with symptomatic cholelithiasis and possible CBD stones. Study Design: Our decision model included 5 treatment strategies: laparoscopic cholecystectomy (LC) alone followed by expectant management; preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by LC; LC with intraoperative cholangiography (IOC) ± common bile duct exploration (CBDE); LC followed by postoperative ERCP; and LC with IOC ± postoperative ERCP. The rates of successful completion of diagnostic testing and therapeutic intervention, test characteristics (sensitivity and specificity), morbidity, and mortality for all procedures are from current literature. Hospitalization costs and lengths of stay are from the 2006 National Centers for Medicare and Medicaid Services data. The probability of CBD stones was varied from 0% to 100% and the most cost-effective strategy was determined at each probability. Results: Across the CBD stone probability range of 4% to 100%, LC with IOC ± ERCP was the most cost-effective. If the probability was 0%, LC alone was the most cost-effective. Our model was sensitive to 1 health input: specificity of IOC, and 3 costs: cost of hospitalization for LC with CBDE, cost of hospitalization for LC without CBDE, and cost of LC with IOC. Conclusions: The most cost-effective treatment strategy for the majority of patients with symptomatic cholelithiasis is LC with routine IOC. If stones are detected, CBDE should be forgone and the patient referred for ERCP.

Original languageEnglish (US)
JournalJournal of the American College of Surgeons
Volume212
Issue number6
DOIs
StatePublished - Jun 2011
Externally publishedYes

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Choledocholithiasis
Laparoscopic Cholecystectomy
Health Care Costs
Common Bile Duct
Cholangiography
Endoscopic Retrograde Cholangiopancreatography
Costs and Cost Analysis
Hospitalization
Cholelithiasis
Centers for Medicare and Medicaid Services (U.S.)
Length of Stay
Therapeutics

ASJC Scopus subject areas

  • Surgery

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Cost-effective treatment of patients with symptomatic cholelithiasis and possible common bile duct stones. / Brown, Lisa M.; Rogers, Stanley J.; Cello, John P.; Brasel, Karen; Inadomi, John M.

In: Journal of the American College of Surgeons, Vol. 212, No. 6, 06.2011.

Research output: Contribution to journalArticle

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