Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada.
Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
J Gastrointest Surg. 2020 Jun;24(6):1314-1319. doi: 10.1007/s11605-019-04268-z. Epub 2019 May 29.
Laparoscopic cholecystectomy is a high-volume surgery that is an end-stage treatment for gallstones. There is little understanding of the surgery's effect on the gain in patients' health relative to its cost. The objective of this study is to measure health gain, cost and cost utility of elective laparoscopic cholecystectomy.
Participants completed the EQ-5D(3L) pre-operatively and post-operatively. Quality adjusted life years attributable to cholecystectomy were calculated by comparing health state utility values between the pre- and post-operative time points. Laparoscopic cholecystectomy cost was calculated from a health system perspective and included hospital and specialists' fees (in 2016 Canadian dollars). Cost per QALY was calculated for the entire sample and demographic sub-groups.
The cohort consisted of 135 participants who completed surveys between February 2013 and June 2017. The response rate among eligible patients was 50%. Assuming that health gain accrued to the participant for 25 years after cholecystectomy, the mean gain in QALYs was 1.7430, corresponding to an average cost per QALY of $2102. Older patients, on average, had less gain in QALYs than younger patients.
Laparoscopic cholecystectomies are inexpensive relative to the gains in health they provide patients. The gains in health were not uniform across age categories. These results should provide health system planners confidence that incremental increases in surgical capacity for elective cholecystectomies is beneficial.
腹腔镜胆囊切除术是一种高容量手术，是治疗胆囊结石的终末期治疗方法。对于该手术相对于其成本对患者健康的增益效果，人们知之甚少。本研究旨在衡量择期腹腔镜胆囊切除术的健康增益、成本和成本效用。
参与者在术前和术后均完成了 EQ-5D（3L）评估。通过比较术前和术后的健康状态效用值，计算出归因于胆囊切除术的质量调整生命年。从卫生系统的角度计算腹腔镜胆囊切除术的成本，包括医院和专家费用（2016 加元）。为整个样本和人口统计学亚组计算了每 QALY 的成本。
该队列由 135 名参与者组成，他们在 2013 年 2 月至 2017 年 6 月之间完成了调查。合格患者的应答率为 50%。假设胆囊切除术后健康增益持续 25 年，平均 QALY 增益为 1.7430，相应的每 QALY 成本为 2102 加元。平均而言，老年患者的 QALY 增益低于年轻患者。
腹腔镜胆囊切除术相对于为患者提供的健康增益而言成本较低。健康收益在不同年龄段之间并不均匀。这些结果应该让卫生系统规划者相信，增加选择性胆囊切除术的手术能力是有益的。
