Bile duct stones and laparoscopic cholecystectomy : a decision analysis to assess the roles of intraoperative cholangiography, EUS, and ERCP.
Annual meeting of the International Society for Technology Assessment in Health Care. Barcelona, ESP, 1997.
The least costly management strategy for patients undergoing laparoscopic cholecystectomy is unclear.
A decision model incorporating cost ratios, test accuracy, complication, and failure rates was used to determine the costs of 4 peri-laparoscopic cholecystectomy strategies : endoscopic retrograde cholangiopancreatography (ERCP), intraoperative cholangiography (IOCG), endoscopic ultrasound (EUS), and expectant management.
Expert IOCG is least costly for intermediate-risk patients when the risk of stones is between 17% and 34%. If expert EUS is available, 0% to 10% ( « low » risk) merits expectant management ; 11% to 55% ( « intermediate » risk) merits EUS ; and greater than 55% ( « high » risk) merits ERCP.
Thresholds were most sensitive to changes in the risks of symptoms and complications due to retained stones ; and to procedural costs, sensitivity, and success rates.
Neither IOCG nor EUS appears likely to reduce overall costs unless their accuracy and success rates are greater than 90% and their procedural cost is less than 60% to 70% that of ERCP.
When neither are available, ERCP is preferable when the risk of stones is greater than 22%. Thresholds were relatively insensitive to changes in the risk and severity of ERCP-induced pancreatitis. (...)
Mots-clés Pascal : Lithiase, Vésicule biliaire, Traitement, Cholécystectomie, Laparoscopie, Indication, Coût, Complication, Incidence, Voie biliaire, Association morbide, Etude comparative, Evaluation performance, Homme, Voie biliaire pathologie, Appareil digestif pathologie, Chirurgie endoscopique, Economie santé
Mots-clés Pascal anglais : Lithiasis, Gallbladder, Treatment, Cholecystectomy, Laparoscopy, Indication, Costs, Complication, Incidence, Biliary tract, Concomitant disease, Comparative study, Performance evaluation, Human, Biliary tract disease, Digestive diseases, Endoscopic surgery, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0172890
Code Inist : 002B25G03. Création : 16/11/1999.