Hepatopancreatobiliary and Liver Transplant Surgery, University Department of Surgery, Royal Free Campus UCL Medical School, London, UK.
Appl Health Econ Health Policy. 2012 Jan 1;10(1):15-29. doi: 10.2165/11594950-000000000-00000.
Patients with gallbladder and common bile duct stones are generally treated by pre-operative endoscopic sphincterotomy (ES) followed by laparoscopic cholecystectomy (POES). Recently, a meta-analysis has shown that intra-operative ES during laparoscopic cholecystectomy (IOES) results in fewer complications than POES, with similar efficacy. The cost effectiveness of IOES versus POES is unknown.
The objective of this study was to compare the cost effectiveness of IOES versus POES from the UK NHS perspective.
A decision-tree model estimating and comparing costs to the UK NHS and QALYs gained following a policy of either IOES or POES was developed with a time horizon of 3 years. Uncertainty was investigated with probabilistic sensitivity analysis, and the expected value of perfect information (EVPI) and partial information (EVPPI) were also calculated.
IOES was less costly than POES (approximately -£623 per patient [year 2008 values]) and resulted in similar quality of life (+0.008 QALYs per patient) as POES. Given a willingness-to-pay threshold of £20 000 per QALY gained, there was a 92.9% probability that IOES is cost effective compared with POES. Full implementation of IOES could save the NHS £2.8 million per annum. At a willingness to pay of £20 000 per QALY gained, the 10-year population EVPI was estimated at £0.6 million.
IOES appears to be cost effective compared with POES.
患有胆囊和胆总管结石的患者通常采用术前内镜下括约肌切开术（ES）联合腹腔镜胆囊切除术（POES）进行治疗。最近，一项荟萃分析表明，腹腔镜胆囊切除术中行内镜下括约肌切开术（IOES）比 POES 术后并发症更少，疗效相当。但 IOES 与 POES 的成本效益比较目前尚不清楚。
本研究旨在从英国国家医疗服务体系（NHS）的角度比较 IOES 与 POES 的成本效益。
采用决策树模型，对英国 NHS 进行了 3 年的成本效益分析，估计并比较了 IOES 与 POES 策略下的成本和获得的 QALYs。采用概率敏感性分析研究了不确定性，并计算了期望信息价值（EVPI）和部分信息价值（EVPPI）。
IOES 比 POES 成本更低（每位患者每年约节省 623 英镑[基于 2008 年的价值]），且对生活质量的影响相似（每位患者增加 0.008 QALYs）。在考虑 2 万英镑/QALY 获益的支付意愿阈值下，IOES 比 POES 更具成本效益的概率为 92.9%。如果全面实施 IOES，NHS 每年可节省 280 万英镑。在支付意愿为 2 万英镑/QALY 获益时，10 年人群 EVPI 估计为 60 万英镑。
与 POES 相比，IOES 似乎具有成本效益。
