Cost–utility analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis

Objective: To compare the cost-effectiveness of early laparoscopic choleystectomy (ELC) versus delayed laparoscopic cholecystectomy (DLC) in patients with acute cholecystitis. Design: A decision-tree model was developed using a series that modelled all potential outcomes for both treatment options. Probabilities were estimated from a Cochrane review. Costs were based on the UK National Schedule of Reference Costs for the year 2006. Setting: UK National Health Service. Patients: Patients with acute cholecystitis. Intervention: Either ELC or DLC with a time frame of 1 year. Main outcome: Outcomes were measured in quality-adjusted life years (QALY) gained over 1 year. Results: Early laparoscopic choleystectomy is less costly and results in better quality of life (+0.05 QALY per patient) than DLC. Given a willingness-to-pay threshold of £20 000 per QALY gained, there is a 70.9% probability that ELC is more cost-effective than DLC. Conclusion: On average, ELC is less expensive and results in better quality of life than DLC.