Oral (pre-recorded)
General HPB 
OG05 General HPB: Cost Effectiveness 
Selection of Presentations from Abstract Submissions
OG05-02 Cost-effectiveness of Restrictive Strategy versus Usual Care for Cholecystectomy in Patients with Gallstones and Abdominal Pain (SECURE-trial)
Carmen Sarah Sophie Latenstein, Netherlands

C.S.S. Latenstein1, S. Wennmacker2, A. van Dijk3, J. Drenth4, G. Westert5, C. van Laarhoven1, M. Boermeester3, P. de Reuver1, M. Dijkgraaf6, SECURE-Trial Collaborators
1Surgery, Radboud University Nijmegen Medical Centre, Netherlands, 2Surgery, Radboudumc, Netherlands, 3Surgery, Amsterdam UMC, Location AMC, Netherlands, 4Gastroenterology and Hepatology, Radboudumc, Netherlands, 5IQ Healthcare, Radboud University Nijmegen Medical Centre, Netherlands, 6Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Location AMC, Netherlands

Background: A restrictive selection strategy for surgery in patients with abdominal pain and uncomplicated gallstone disease significantly reduces cholecystectomies, but the impact on overall costs is unknown. The aim of this study was to perform a cost-effectiveness analysis (CEA) of restrictive strategy versus usual care.
Methods: Data of a multicentre, randomized-controlled trial (SECURE-trial) were used. Restrictive strategy for patients with gallstones was economically evaluated against usual care as best alternative from a societal perspective. Hospital-use of resources was gathered with case-report forms and out-of-hospital consultations, out-of-pocket expenses, and productivity loss were collected with questionnaires. National unit costing was applied. The primary outcome was the cost per pain-free patient at 12 months post-randomization.
Results: All 1067 randomized patients (49.0 years, 73.7% females) were included, 537 patients in usual care and 530 in restrictive strategy. After 12 months, 56.2% of patients were pain-free in restrictive strategy versus 59.8% after usual care. The restrictive strategy significantly reduced the cholecystectomy rate with 7.7% and reduced surgical costs by €160 (P=0.003) per patient, €162 was saved from a societal perspective. The cost-effectiveness plane showed that restrictive strategy was cost saving in 89.1% of all samples and less effective in 88.5%. Overall, costs savings of the restrictive strategy did not sufficiently compensate for the accompanying loss in pain-free patients.
Conclusion: This CEA shows that restrictive strategy for treatment of uncomplicated cholecystolithiasis saved €162 compared to usual care from a societal perspective. However, savings by restrictive strategy could not compensate for the lower proportion of pain-free patients.
OG05-03 Health Economic Evaluation of Patients with Colorectal Liver Metastases Randomized to ALPPS or TSH - Analysis from the LIGRO Trial
Kristina Hasselgren, Sweden

K. Hasselgren1, M. Henriksson2, B. Røsok3, P. Larsen4, E. Sparrelid5, G. Lindell6, B. Isaksson7, P. Sandström1, B. Björnsson1
1Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University Hospital, Sweden, 2Centre for Medical Technology Assessment, Linköping University, Sweden, 3Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Norway, 4Department of Surgical Gastroenterology and Transplantation, University of Copenhagen, Denmark, 5Department of Clinical Science, Intervention and Technology, Divison of Surgery, Karolinska University Hospital, Sweden, 6Department of Surgery, Skane University Hospital, Sweden, 7Department of Surgery, Akademiska University Hospital, Sweden

Introduction: Two-staged hepatectomy (TSH), is an established method in advanced colorectal liver metastases (CRLM). Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has emerged providing improved resection rate and survival.
The health care costs and health outcomes, combining health related quality of life (HRQoL) and survival into quality-adjusted life years (QALYs), of ALPPS and TSH have not previously been evaluated and compared.
Methods: This is a pre-planned, health economic evaluation from the LIGRO trial. One hundred patients with CRLM and standardized FLR < 30 % were randomized to ALPPS or TSH.
Costs and QALYs were compared from treatment start up to 2 years. Costs are estimated from resource use, including all surgical interventions, length of stay after interventions, diagnostic procedures and chemotherapy and applying Swedish unit costs. QALYs were estimated by combining survival and HRQoL data, the latter being assessed with EQ-5D 3L. Estimated costs and QALYs for each treatment strategy were combined into an incremental cost-effectiveness ratio (ICER). Non-parametric bootstrapping was used to assess the joint distribution of incremental costs and QALYs.
Results: The mean cost difference between ALPPS and TSH was 12662€, (95% CI -10728-36051, p=0.283). Corresponding mean difference in life years and QALYs was 0.1296 (95% CI -0.12-0.38, p=0.314) and 0.1285 (95% CI -0.11-0.36, p=0.28), respectively. The ICER was 93186 and 92414 for QALYs and life-years as outcomes, respectively.
Conclusion: Based on the two-year data, the cost-effectiveness of ALPPS is uncertain. Further research, exploring cost and health outcomes beyond 2 year is needed.