Cost-effective treatment of patients with symptomatic cholelithiasis and possible common bile duct stones.
Cost-effective treatment of patients with symptomatic cholelithiasis and possible common bile duct stones.
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DOI：
10.1016/j.jamcollsurg.2011.02.017
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发表时间：
2011-06
影响因子：
5.2
通讯作者：
Inadomi, John M.
中科院分区：
文献类型：
--
作者：
Brown, Lisa M.;Rogers, Stanley J.;Cello, John P.;Brasel, Karen J.;Inadomi, John M.
Clinicians must choose a treatment strategy for patients with symptomatic cholelithiasis without knowing whether common bile duct (CBD) stones are present. The purpose of this study was to determine the most cost-effective treatment strategy for patients with symptomatic cholelithiasis and possible CBD stones. Our decision model included five treatment strategies: (1) laparoscopic cholecystectomy (LC) alone followed by expectant management, (2) preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by LC, (3) LC with intraoperative cholangiography (IOC) ± common bile duct exploration (CBDE), (4) LC followed by postoperative ERCP, and (5) LC with IOC ± postoperative ERCP. The rates of successful completion of diagnostic testing and therapeutic intervention, test characteristics (sensitivity and specificity), morbidity, and mortality for all procedures are from current literature. Hospitalization costs and lengths of stay are from the 2006 National CMS data. The probability of CBD stones was varied from 0% to 100% and the most cost-effective strategy was determined at each probability. Across the CBD stone probability range of 4% to 100%, LC with IOC ± ERCP was the most cost-effective. If the probability was 0%, LC alone was the most cost-effective. Our model was sensitive to one health input: specificity of IOC, and three costs: cost of hospitalization for LC with CBDE, cost of hospitalization for LC without CBDE, and cost of LC with IOC. The most cost-effective treatment strategy for the majority of patients with symptomatic cholelithiasis is LC with routine IOC. If stones are detected, CBDE should be forgone and the patient referred for ERCP.
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影响因子：
7.7
作者：
Christensen, M;Matzen, P;Rosenberg, J
通讯作者：
Rosenberg, J
影响因子：
9
作者：
Collins, C;Maguire, D;O'Sullivan, GC
通讯作者：
O'Sullivan, GC
影响因子：
7.7
作者：
Abraham, NS;Williams, SP;MacIntosh, DG
通讯作者：
MacIntosh, DG
DOI：
10.1007/s00464-001-8325-1
发表时间：
2002-02-01
影响因子：
3.1
作者：
Halpin, VJ;Dunnegan, D;Soper, NJ
通讯作者：
Soper, NJ
DOI：
10.1155/1996/64373
发表时间：
1996-01-01
期刊：
HPB surgery : a world journal of hepatic, pancreatic and biliary surgery
影响因子：
--
作者：
Kapoor, R;Kaushik, S P;Kapoor, V K
通讯作者：
Kapoor, V K