Abstract
Background and study aims Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is the preferred treatment
for patients with acute calculous cholecystitis who are unfit for surgery. The aim
of this study was to perform a cost-effective analysis (CEA) comparing EUS-GBD with
percutaneous gallbladder drainage (PT-GBD).
Patients and methods CEA was performed on patients recruited for our prior randomized controlled trial.
A budget impact model was developed to compare the base-case and scenario of EUS-GBD
applications. The costs including peri-procedure and intra-procedure, reinterventions,
expenses associated with treatment of adverse events (AEs), costs of hospital stay,
subsequent clinic follow-up, and unplanned readmission were included.
Results PT-GBD had a lower total procedure cost per patient (USD$4,375.00) than EUS-GBD (USD$9,397.44).
For EUS-GBD, the cost of cautery-enhanced lumen-apposing stent accounted for the major
part of the expense (USD$4,910.26). EUS-GBD resulted in a lower expected cost (USD$108.26
vs USD$1,601.54) for a re-procedure. The expected cost per patient in unplanned readmissions
in the EUS-GBD group (USD$450.00) was lower than that in the PT-GBD group (USD$1,717.56).
Based on the budget impact analysis, the net budget impact per year of introducing
EUS-GBD to replace PT-GBD was higher (USD$16,424.10 vs USD$11,433.08). The net budget
impact was most sensitive to the cost of stent and linear echoendoscope used in EUS-GBD.
Conclusions The net budget impact per year was higher for introducing EUS-GBD. The cost of the
stent accounted for the major cost difference between the two procedures. EUS-GBD
saved on the cost in management of AEs, reinterventions, and unplanned readmissions
but these did not offset the cost of the stent.
