Previously reported clinical results from the trial showed that performing cholecystectomy within 24 hours of admission (early) versus after clinical resolution (late/control) in adults predicted to have mild gallstone pancreatitis significantly reduced time spent in the hospital by about one day, without increasing major postoperative complications (https://bit.ly/3jlRr1k).
Results of a secondary economic analysis suggest lower 90-day average total costs with early rather than late cholecystectomy ($14,974 vs. $16,190; cost ratio, 0.92; 95% confidence interval: 0.73 to 1.15), report Dr. Lillian Kao and colleagues of the University of Texas Health Science Center at Houston in the Journal of the American College of Surgeons.
The average cost difference per patient was $1,216 (95% CI, -$4,782 to $2,349). On Bayesian analysis, the early approach had an 81% probability of reducing 90-day healthcare system costs.
"Gallstone pancreatitis is a common emergency general surgery problem in the United States, accounting for up to 50% of all pancreatitis cases. The cost of treating gallstone pancreatitis is estimated to be US $2.2 billion annually as of 2014," the authors note in their article.
"Despite the higher incidence of minor complications and readmissions, patients undergoing early cholecystectomy had a lower rate of endoscopic retrograde cholangiopancreatography (ERCP), shorter overall 90-day hospital length of stay and a high probability of having lower health system costs relative to late cholecystectomy," they say.
A major limitation of this study is the small sample size - 49 in the early group and 48 in the late group.
They say the results of this analysis should be regarded as "hypothesis-generating," with the findings indicating a high probability for early cholecystectomy to be cost saving from a health systems perspective.
"Another important limitation of the study is the uncertain generalizability to other centers. Our trial involved a single high-volume safety-net hospital with a cost structure and patient population that may differ from other centers," they point out.
The researchers say their analysis likely underestimates the cost saving from performing early cholecystectomy because they only analyzed direct medical costs.
"By excluding costs from a societal perspective, we may have underestimated the true cost savings of early cholecystectomy for mild gallstone pancreatitis - a condition that predominantly affects working-age adults," they write.
"Larger, multicenter trials are needed to confirm this finding within other healthcare systems and to explore cost savings from a societal perspective," the authors conclude.
SOURCE: https://bit.ly/3xnwKa7 Journal of the American College of Surgeons, online July 26, 2021.
By Reuters Staff
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