Cost-effectiveness of early laparoscopic cholecystectomy for mild acute gallstone pancreatitis

Background A recent Cochrane review suggested that laparoscopic cholecystectomy carried out early following mild gallstone pancreatitis was safe. This study compared the cost‐effectiveness of laparoscopic cholecystectomy performed within 3 days of admission, during the same admission but after more than 3 days, or electively in a subsequent admission. Methods A model‐based cost–utility analysis was performed estimating mean costs and quality‐adjusted life‐years (QALYs) per patient in the UK National Health Service with a 1‐year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources for mild gallstone pancreatitis, including one‐way and probabilistic sensitivity analyses. Results The costs of laparoscopic cholecystectomy performed within 3 days of admission, beyond 3 days but in the same admission, and electively in a subsequent admission were €2748, €3543 and €3752 respectively; the QALYs were 0·888, 0·888 and 0·884 respectively. Early laparoscopic cholecystectomy had a 91 per cent probability of being cost‐effective at the maximum willingness to pay for a QALY commonly used in the UK. It is acknowledged that many hospitals do not have access to magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography, especially at weekends, and that implementing a 3‐day target is unrealistic without allocating new resources that could erode the cost‐effectiveness. Conclusion Performing laparoscopic cholecystectomy for mild gallstone pancreatitis within 3 days of admission is cost‐effective, but may not be feasible without significant resource allocation. After 3 days there is little financial advantage to same‐admission operation. Would require significant resources