Cost-effectiveness of trans-abdominal ultrasound for gallbladder cancer surveillance in patients with gallbladder polyps less than 10 mm in the United Kingdom.

IF 1.8 4区 医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Julia Lowin, Bernadette Sewell, Matthew Prettyjohns, Angela Farr, Kieran G Foley
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引用次数: 0

Abstract

Objective: Gallbladder polyps (GBPs) are commonly detected with trans-abdominal ultrasound (TAUS). Gallbladder cancer (GBC) is associated with GBPs but the risk of malignancy is low. International guidelines recommend ultrasound surveillance (USS) in selected cases of GBPs <10mm, with cholecystectomy advised if polyp size increases. USS (including potential surgeries) is resource intense. We evaluated the costs and potential cost-effectiveness of USS in a theoretical UK patient cohort with GBPs.

Methods: A health economic model mapped expected management pathways over 2-years for 1,000 GBP patients with and without USS, stratified by initial size of GBP (<6mm and 6-9mm). We estimated USS resource and costs under alternate thresholds for surgery. Clinical data were extracted from a large-scale cohort study. TAUS and surgery costs were based on NHS tariffs. GBC costs were estimated from the literature. Outcomes included USS costs, expected numbers of GBC and incremental cost for each case of GBC avoided.

Results: The 2-year additional cohort costs of USS (n=number of additional surgeries) were estimated between £213,441 (n = 50) and £750,045 (n = 253) in GBPs <6mm, and between £420,275 (n = 165) and £531,297 (n = 207) in GBPs 6-9mm, balanced against avoidance of 1.3 (<6mm) and 8.7 (6-9mm) cases of GBC. Model findings were robust to plausible changes in inputs.

Conclusions: Using published data, we demonstrated that, in patients with GBPs <10mm, the costs of USS to avoid GBC outweigh potential GBC cost offsets, and would result in high rates of cholecystectomy. Additional evidence is needed to establish the formal cost-effectiveness of GBP USS in the UK.

在英国,经腹超声对胆囊息肉小于10毫米的患者进行胆囊癌监测的成本-效果。
目的:胆囊息肉(GBPs)是经腹超声(TAUS)检测的常用方法。胆囊癌(GBC)与GBPs相关,但恶性肿瘤的风险较低。国际指南推荐在选定的GBPs病例中使用超声监测(USS)方法:一个健康经济模型绘制了1000名有或没有USS的GBPs患者2年内的预期管理路径,按初始GBPs的大小分层(结果:USS的2年额外队列成本(n=额外手术次数)估计在213,441英镑(n= 50)和750,045英镑(n= 253)之间)
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
British Journal of Radiology
British Journal of Radiology 医学-核医学
CiteScore
5.30
自引率
3.80%
发文量
330
审稿时长
2-4 weeks
期刊介绍: BJR is the international research journal of the British Institute of Radiology and is the oldest scientific journal in the field of radiology and related sciences. Dating back to 1896, BJR’s history is radiology’s history, and the journal has featured some landmark papers such as the first description of Computed Tomography "Computerized transverse axial tomography" by Godfrey Hounsfield in 1973. A valuable historical resource, the complete BJR archive has been digitized from 1896. Quick Facts: - 2015 Impact Factor – 1.840 - Receipt to first decision – average of 6 weeks - Acceptance to online publication – average of 3 weeks - ISSN: 0007-1285 - eISSN: 1748-880X Open Access option
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