Cost-effectiveness analysis of cholecystectomy during Roux-en-Y gastric bypass for morbid obesity

Jaime Benarroch-Gampel, David R. Lairson, Casey A. Boyd, Kristin M. Sheffield, Vivian Ho, Taylor S. Riall

    Research output: Contribution to journalArticle

    24 Citations (Scopus)

    Abstract

    Background: Controversy exists regarding the use of concurrent cholecystectomy during Roux-en-Y gastric bypass performed for morbid obesity. Methods: A decision model was developed to evaluate the cost-effectiveness of current strategies: routine concurrent cholecystectomy, Roux-en-Y gastric bypass alone with or without postoperative ursodiol therapy, and selective cholecystectomy based on preoperative findings on ultrasonography. Probabilities were obtained from a comprehensive literature review. Costs and hospital days were obtained from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. One-way sensitivity analyses were performed. Results: The least expensive strategy was to perform RYGB alone without preoperative ultrasonography, with an average cost (over RYGB costs) of $537 per patient. RYGB with concurrent cholecystectomy had a cost of $631. Selective cholecystectomy based on preoperative ultrasonography was dominated by the other 2 strategies. Our model was most sensitive to the probability of developing gallbladder-related symptoms after RYGB alone. When the incidence of gallbladder-related symptoms was <4.6%, the dominant strategy was to perform a RYGB alone without preoperative ultrasonography. For values >6.9%, performing concurrent cholecystectomy at the time of the RYGB was superior to other strategies. When ursodiol was used, the least expensive strategy was to perform a concurrent cholecystectomy during RYGB. Conclusion: The main factor determining the most cost-effective strategy is the incidence of gallbladder-related symptoms after RYGB. The use of ursodiol was associated with an increase in cost that does not justify its use after RYGB. Finally, selective cholecystectomy based on preoperative ultrasonography was dominated by the other strategies in the scenarios evaluated.

    Original languageEnglish (US)
    Pages (from-to)363-375
    Number of pages13
    JournalSurgery (United States)
    Volume152
    Issue number3
    DOIs
    StatePublished - Sep 2012

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    Gastric Bypass
    Morbid Obesity
    Cholecystectomy
    Cost-Benefit Analysis
    Ursodeoxycholic Acid
    Ultrasonography
    Costs and Cost Analysis
    Gallbladder
    Hospital Costs
    Incidence
    Health Care Costs
    Inpatients

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Benarroch-Gampel, J., Lairson, D. R., Boyd, C. A., Sheffield, K. M., Ho, V., & Riall, T. S. (2012). Cost-effectiveness analysis of cholecystectomy during Roux-en-Y gastric bypass for morbid obesity. Surgery (United States), 152(3), 363-375. https://doi.org/10.1016/j.surg.2012.06.013

    Cost-effectiveness analysis of cholecystectomy during Roux-en-Y gastric bypass for morbid obesity. / Benarroch-Gampel, Jaime; Lairson, David R.; Boyd, Casey A.; Sheffield, Kristin M.; Ho, Vivian; Riall, Taylor S.

    In: Surgery (United States), Vol. 152, No. 3, 09.2012, p. 363-375.

    Research output: Contribution to journalArticle

    Benarroch-Gampel, J, Lairson, DR, Boyd, CA, Sheffield, KM, Ho, V & Riall, TS 2012, 'Cost-effectiveness analysis of cholecystectomy during Roux-en-Y gastric bypass for morbid obesity', Surgery (United States), vol. 152, no. 3, pp. 363-375. https://doi.org/10.1016/j.surg.2012.06.013
    Benarroch-Gampel, Jaime ; Lairson, David R. ; Boyd, Casey A. ; Sheffield, Kristin M. ; Ho, Vivian ; Riall, Taylor S. / Cost-effectiveness analysis of cholecystectomy during Roux-en-Y gastric bypass for morbid obesity. In: Surgery (United States). 2012 ; Vol. 152, No. 3. pp. 363-375.
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    abstract = "Background: Controversy exists regarding the use of concurrent cholecystectomy during Roux-en-Y gastric bypass performed for morbid obesity. Methods: A decision model was developed to evaluate the cost-effectiveness of current strategies: routine concurrent cholecystectomy, Roux-en-Y gastric bypass alone with or without postoperative ursodiol therapy, and selective cholecystectomy based on preoperative findings on ultrasonography. Probabilities were obtained from a comprehensive literature review. Costs and hospital days were obtained from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. One-way sensitivity analyses were performed. Results: The least expensive strategy was to perform RYGB alone without preoperative ultrasonography, with an average cost (over RYGB costs) of $537 per patient. RYGB with concurrent cholecystectomy had a cost of $631. Selective cholecystectomy based on preoperative ultrasonography was dominated by the other 2 strategies. Our model was most sensitive to the probability of developing gallbladder-related symptoms after RYGB alone. When the incidence of gallbladder-related symptoms was <4.6{\%}, the dominant strategy was to perform a RYGB alone without preoperative ultrasonography. For values >6.9{\%}, performing concurrent cholecystectomy at the time of the RYGB was superior to other strategies. When ursodiol was used, the least expensive strategy was to perform a concurrent cholecystectomy during RYGB. Conclusion: The main factor determining the most cost-effective strategy is the incidence of gallbladder-related symptoms after RYGB. The use of ursodiol was associated with an increase in cost that does not justify its use after RYGB. Finally, selective cholecystectomy based on preoperative ultrasonography was dominated by the other strategies in the scenarios evaluated.",
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    AB - Background: Controversy exists regarding the use of concurrent cholecystectomy during Roux-en-Y gastric bypass performed for morbid obesity. Methods: A decision model was developed to evaluate the cost-effectiveness of current strategies: routine concurrent cholecystectomy, Roux-en-Y gastric bypass alone with or without postoperative ursodiol therapy, and selective cholecystectomy based on preoperative findings on ultrasonography. Probabilities were obtained from a comprehensive literature review. Costs and hospital days were obtained from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. One-way sensitivity analyses were performed. Results: The least expensive strategy was to perform RYGB alone without preoperative ultrasonography, with an average cost (over RYGB costs) of $537 per patient. RYGB with concurrent cholecystectomy had a cost of $631. Selective cholecystectomy based on preoperative ultrasonography was dominated by the other 2 strategies. Our model was most sensitive to the probability of developing gallbladder-related symptoms after RYGB alone. When the incidence of gallbladder-related symptoms was <4.6%, the dominant strategy was to perform a RYGB alone without preoperative ultrasonography. For values >6.9%, performing concurrent cholecystectomy at the time of the RYGB was superior to other strategies. When ursodiol was used, the least expensive strategy was to perform a concurrent cholecystectomy during RYGB. Conclusion: The main factor determining the most cost-effective strategy is the incidence of gallbladder-related symptoms after RYGB. The use of ursodiol was associated with an increase in cost that does not justify its use after RYGB. Finally, selective cholecystectomy based on preoperative ultrasonography was dominated by the other strategies in the scenarios evaluated.

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