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Brian R. Davidson - One of the best experts on this subject based on the ideXlab platform.

  • Intra-operative vs pre-operative endoscopic sphincterotomy in patients with gallbladder and common bile duct stones
    Applied Health Economics and Health Policy, 2012
    Co-Authors: Kurinchi Gurusamy, Edward Wilson, Andrew K. Burroughs, Brian R. Davidson
    Abstract:

    Background Patients with gallbladder and common bile duct stones are generally treated by pre-operative endoscopic sphincterotomy (ES) followed by laparoscopic cholecystectomy (POES). Recently, a meta-analysis has shown that intra-operative ES during laparoscopic cholecystectomy (IOES) results in fewer complications than POES, with similar efficacy. The cost effectiveness of IOES versus POES is unknown. Objective The objective of this study was to compare the cost effectiveness of IOES versus POES from the UK NHS perspective. Methods A decision-tree model estimating and comparing costs to the UK NHS and QALYs gained following a policy of either IOES or POES was developed with a time horizon of 3 years. Uncertainty was investigated with probabilistic sensitivity analysis, and the expected value of perfect information (EVPI) and partial information (EVPPI) were also calculated. Results IOES was less costly than POES (approximately −£623 per patient [year 2008 values]) and resulted in similar quality of life (+0.008 QALYs per patient) as POES. Given a willingness-to-pay threshold of £20 000 per QALY gained, there was a 92.9% probability that IOES is cost effective compared with POES. Full implementation of IOES could save the NHS £2.8 million per annum. At a willingness to pay of £20 000 per QALY gained, the 10-year population EVPI was estimated at £0.6 million. Conclusions IOES appears to be cost effective compared with POES.

  • systematic review and meta analysis of intraoperative versus preoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones
    British Journal of Surgery, 2011
    Co-Authors: Kurinchi Gurusamy, Andrew K. Burroughs, S J Sahay, Brian R. Davidson
    Abstract:

    Background: Most patients with gallbladder and common bile duct stones are treated by preoperative endoscopic sphincterotomy (POES) followed by laparoscopic cholecystectomy. Recently, intraoperative endoscopic sphincterotomy (IOES) during laparoscopic cholecystectomy has been suggested as an alternative treatment.Methods: Data from randomized clinical trials related to safety and effectiveness of IOES versus POES were extracted by two independent reviewers. Risk ratios (RRs) or mean differences were calculated with 95 per cent confidence intervals based on intention-to-treat analysis whenever possible.Results: Four trials with 532 patients comparing IOES with POES were included. There were no deaths. There was no significant difference in rates of ampullary cannulation (RR 1.01, 0.97 to 1.04; P = 0.70) or stone clearance by ES (RR 0.99, 0.96 to 1.02; P = 0.58) between the groups. The proportion of patients with at least one post-ES complication, including pancreatitis, bleeding, perforation, cholangitis, cholecystitis or gastric ulcer, was significantly lower in the IOES group (RR 0.37, 0.18 to 0.78; P = 0.009). There was no significant difference in morbidity after laparoscopic cholecystectomy or requirement for open operation between the groups. Mean hospital stay was 3 days shorter in the IOES group: mean difference -2.83 (-3.66 to -2.00) days (P < 0.001).Conclusion: In patients with gallbladder and common bile duct stones, IOES is as effective and safe as POES and results in a significantly shorter hospital stay.

Kurinchi Gurusamy - One of the best experts on this subject based on the ideXlab platform.

  • Intra-operative vs pre-operative endoscopic sphincterotomy in patients with gallbladder and common bile duct stones
    Applied Health Economics and Health Policy, 2012
    Co-Authors: Kurinchi Gurusamy, Edward Wilson, Andrew K. Burroughs, Brian R. Davidson
    Abstract:

    Background Patients with gallbladder and common bile duct stones are generally treated by pre-operative endoscopic sphincterotomy (ES) followed by laparoscopic cholecystectomy (POES). Recently, a meta-analysis has shown that intra-operative ES during laparoscopic cholecystectomy (IOES) results in fewer complications than POES, with similar efficacy. The cost effectiveness of IOES versus POES is unknown. Objective The objective of this study was to compare the cost effectiveness of IOES versus POES from the UK NHS perspective. Methods A decision-tree model estimating and comparing costs to the UK NHS and QALYs gained following a policy of either IOES or POES was developed with a time horizon of 3 years. Uncertainty was investigated with probabilistic sensitivity analysis, and the expected value of perfect information (EVPI) and partial information (EVPPI) were also calculated. Results IOES was less costly than POES (approximately −£623 per patient [year 2008 values]) and resulted in similar quality of life (+0.008 QALYs per patient) as POES. Given a willingness-to-pay threshold of £20 000 per QALY gained, there was a 92.9% probability that IOES is cost effective compared with POES. Full implementation of IOES could save the NHS £2.8 million per annum. At a willingness to pay of £20 000 per QALY gained, the 10-year population EVPI was estimated at £0.6 million. Conclusions IOES appears to be cost effective compared with POES.

  • systematic review and meta analysis of intraoperative versus preoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones
    British Journal of Surgery, 2011
    Co-Authors: Kurinchi Gurusamy, Andrew K. Burroughs, S J Sahay, Brian R. Davidson
    Abstract:

    Background: Most patients with gallbladder and common bile duct stones are treated by preoperative endoscopic sphincterotomy (POES) followed by laparoscopic cholecystectomy. Recently, intraoperative endoscopic sphincterotomy (IOES) during laparoscopic cholecystectomy has been suggested as an alternative treatment.Methods: Data from randomized clinical trials related to safety and effectiveness of IOES versus POES were extracted by two independent reviewers. Risk ratios (RRs) or mean differences were calculated with 95 per cent confidence intervals based on intention-to-treat analysis whenever possible.Results: Four trials with 532 patients comparing IOES with POES were included. There were no deaths. There was no significant difference in rates of ampullary cannulation (RR 1.01, 0.97 to 1.04; P = 0.70) or stone clearance by ES (RR 0.99, 0.96 to 1.02; P = 0.58) between the groups. The proportion of patients with at least one post-ES complication, including pancreatitis, bleeding, perforation, cholangitis, cholecystitis or gastric ulcer, was significantly lower in the IOES group (RR 0.37, 0.18 to 0.78; P = 0.009). There was no significant difference in morbidity after laparoscopic cholecystectomy or requirement for open operation between the groups. Mean hospital stay was 3 days shorter in the IOES group: mean difference -2.83 (-3.66 to -2.00) days (P < 0.001).Conclusion: In patients with gallbladder and common bile duct stones, IOES is as effective and safe as POES and results in a significantly shorter hospital stay.

Yi Si - One of the best experts on this subject based on the ideXlab platform.

Andrew K. Burroughs - One of the best experts on this subject based on the ideXlab platform.

  • Intra-operative vs pre-operative endoscopic sphincterotomy in patients with gallbladder and common bile duct stones
    Applied Health Economics and Health Policy, 2012
    Co-Authors: Kurinchi Gurusamy, Edward Wilson, Andrew K. Burroughs, Brian R. Davidson
    Abstract:

    Background Patients with gallbladder and common bile duct stones are generally treated by pre-operative endoscopic sphincterotomy (ES) followed by laparoscopic cholecystectomy (POES). Recently, a meta-analysis has shown that intra-operative ES during laparoscopic cholecystectomy (IOES) results in fewer complications than POES, with similar efficacy. The cost effectiveness of IOES versus POES is unknown. Objective The objective of this study was to compare the cost effectiveness of IOES versus POES from the UK NHS perspective. Methods A decision-tree model estimating and comparing costs to the UK NHS and QALYs gained following a policy of either IOES or POES was developed with a time horizon of 3 years. Uncertainty was investigated with probabilistic sensitivity analysis, and the expected value of perfect information (EVPI) and partial information (EVPPI) were also calculated. Results IOES was less costly than POES (approximately −£623 per patient [year 2008 values]) and resulted in similar quality of life (+0.008 QALYs per patient) as POES. Given a willingness-to-pay threshold of £20 000 per QALY gained, there was a 92.9% probability that IOES is cost effective compared with POES. Full implementation of IOES could save the NHS £2.8 million per annum. At a willingness to pay of £20 000 per QALY gained, the 10-year population EVPI was estimated at £0.6 million. Conclusions IOES appears to be cost effective compared with POES.

  • systematic review and meta analysis of intraoperative versus preoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones
    British Journal of Surgery, 2011
    Co-Authors: Kurinchi Gurusamy, Andrew K. Burroughs, S J Sahay, Brian R. Davidson
    Abstract:

    Background: Most patients with gallbladder and common bile duct stones are treated by preoperative endoscopic sphincterotomy (POES) followed by laparoscopic cholecystectomy. Recently, intraoperative endoscopic sphincterotomy (IOES) during laparoscopic cholecystectomy has been suggested as an alternative treatment.Methods: Data from randomized clinical trials related to safety and effectiveness of IOES versus POES were extracted by two independent reviewers. Risk ratios (RRs) or mean differences were calculated with 95 per cent confidence intervals based on intention-to-treat analysis whenever possible.Results: Four trials with 532 patients comparing IOES with POES were included. There were no deaths. There was no significant difference in rates of ampullary cannulation (RR 1.01, 0.97 to 1.04; P = 0.70) or stone clearance by ES (RR 0.99, 0.96 to 1.02; P = 0.58) between the groups. The proportion of patients with at least one post-ES complication, including pancreatitis, bleeding, perforation, cholangitis, cholecystitis or gastric ulcer, was significantly lower in the IOES group (RR 0.37, 0.18 to 0.78; P = 0.009). There was no significant difference in morbidity after laparoscopic cholecystectomy or requirement for open operation between the groups. Mean hospital stay was 3 days shorter in the IOES group: mean difference -2.83 (-3.66 to -2.00) days (P < 0.001).Conclusion: In patients with gallbladder and common bile duct stones, IOES is as effective and safe as POES and results in a significantly shorter hospital stay.

Bin Wang - One of the best experts on this subject based on the ideXlab platform.

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