Department of Hepatobiliary and Transplant Surgery St Vincent's University Hospital Elm Park, Dublin 4 Ireland, D04 T6F4.
BJS Open. 2019 Feb 12;3(2):146-152. doi: 10.1002/bjs5.50120. eCollection 2019 Apr.
Acute calculous cholecystitis (ACC) is a common disease across the world and is associated with significant socioeconomic costs. Although contemporary guidelines support the role of early laparoscopic cholecystectomy (ELC), there is significant variation among units adopting it as standard practice. There are many resource implications of providing a service whereby cholecystectomies for acute cholecystitis can be performed safely.
Studies that incorporated an economic analysis comparing early with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis were identified by means of a systematic review. A meta-analysis was performed on those cost evaluations. The quality of economic valuations contained therein was evaluated using the Quality of Health Economic Studies (QHES) analysis score.
Six studies containing cost analyses were included in the meta-analysis with 1128 patients. The median healthcare cost of ELC DLC was €4400 and €6004 respectively. Five studies had adequate data for pooled analysis. The standardized mean difference between ELC and DLC was -2·18 (95 per cent c.i. -3·86 to -0·51; = 0·011; = 98·7 per cent) in favour of ELC. The median QHES score for the included studies was 52·17 (range 41-72), indicating overall poor-to-fair quality.
Economic evaluations within clinical trials favour ELC for ACC. The limited number and poor quality of economic evaluations are noteworthy.
急性结石性胆囊炎（ACC）是一种在世界各地都很常见的疾病，与巨大的社会经济成本相关。尽管当代指南支持早期腹腔镜胆囊切除术（ELC）的作用，但在将其作为标准实践采用方面，各单位之间存在显著差异。提供一种服务需要考虑许多资源问题，即可以安全地对急性胆囊炎患者进行胆囊切除术。
通过系统评价，确定了将早期与延迟腹腔镜胆囊切除术（DLC）治疗急性胆囊炎进行经济分析比较的研究。对这些成本评估进行了荟萃分析。使用健康经济研究质量评估（QHES）分析评分来评估其中经济评估的质量。
荟萃分析纳入了 6 项包含成本分析的研究，共有 1128 名患者。ELC-DLC 的中位医疗保健成本分别为 4400 欧元和 6004 欧元。五项研究有足够的数据进行汇总分析。ELC 与 DLC 之间的标准化均数差值为-2.18（95%置信区间-3.86 至-0.51；P=0.011；=98.7%），有利于 ELC。纳入研究的中位数 QHES 评分为 52.17（范围 41-72），表明整体质量较差至一般。
临床试验中的经济评估支持 ELC 用于 ACC。值得注意的是，经济评估的数量有限且质量较差。
