|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
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
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.