Cost effectiveness of endoscopic gallbladder drainage to treat acute cholecystitis in poor surgical candidates.

摘要: Endoscopic gallbladder drainage (GBD) is an alternative to percutaneous GBD (PGBD) treat acute cholecystitis, yielding similar success rates and fewer adverse events. To our knowledge, no cost-effectiveness analysis has compared these procedures. We performed economic identify clinical cost determinants of three treatment options for cholecystitis in poor surgical candidates. strategies: PGBD, endoscopic retrograde cholangiographic transpapillary (ERC-GBD), endosonographic (EUS-GBD). A decision tree was created over a 3-month period. Effectiveness measured using hospital length stay, including events readmissions. Costs care were calculated from the National Inpatient Sample. Technical estimates obtained published literature. Cost effectiveness as incremental national average one bed per diem. Analysis hypothetical cohort candidates cholecystectomy showed that, ERC-GBD cost-saving strategy EUS-GBD effective, requiring $1312 hospitalization day averted. Additional costs interventions less than Compared ERC-GBD, required expending additional $8950 prevent hospitalization. Our model considerably affected by lumen-apposing metal stent stay patients managed conservatively those delayed surgery. effective favoring EUS-GBD. Further efforts are needed make available more medical centers, reduce equipment costs, shorten inpatient stay.