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Cost-effectiveness of ursodeoxycholic acid in preventing new-onset symptomatic gallstone disease after Roux-en-Y gastric bypass surgery

BACKGROUND: The aim was to evaluate the cost-effectiveness and cost–utility of ursodeoxycholic acid (UDCA) prophylaxis for the prevention of symptomatic gallstone disease after Roux-en-Y gastric bypass (RYGB) in patients without gallstones before surgery. METHODS: Data from a multicentre, double-bli...

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Autores principales: Haal, Sylke, Guman, Maimoena S S, de Brauw, L Maurits, Schouten, Ruben, van Veen, Ruben N, Fockens, Paul, Gerdes, Victor E A, Voermans, Rogier P, Dijkgraaf, Marcel G W
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10364680/
https://www.ncbi.nlm.nih.gov/pubmed/35979609
http://dx.doi.org/10.1093/bjs/znac273
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author Haal, Sylke
Guman, Maimoena S S
de Brauw, L Maurits
Schouten, Ruben
van Veen, Ruben N
Fockens, Paul
Gerdes, Victor E A
Voermans, Rogier P
Dijkgraaf, Marcel G W
author_facet Haal, Sylke
Guman, Maimoena S S
de Brauw, L Maurits
Schouten, Ruben
van Veen, Ruben N
Fockens, Paul
Gerdes, Victor E A
Voermans, Rogier P
Dijkgraaf, Marcel G W
author_sort Haal, Sylke
collection PubMed
description BACKGROUND: The aim was to evaluate the cost-effectiveness and cost–utility of ursodeoxycholic acid (UDCA) prophylaxis for the prevention of symptomatic gallstone disease after Roux-en-Y gastric bypass (RYGB) in patients without gallstones before surgery. METHODS: Data from a multicentre, double-blind, randomized placebo-controlled superiority trial were used. Patients scheduled for laparoscopic RYGB or sleeve gastrectomy were randomized to receive 900 mg UDCA or placebo for 6 months. Indicated by the clinical report, prophylactic prescription of UDCA was evaluated economically against placebo from a healthcare and societal perspective for the subgroup of patients without gallstones before surgery who underwent RYGB. Volumes and costs of in-hospital care, out-of-hospital care, out-of-pocket expenses, and productivity loss were assessed. Main outcomes were the costs per patient free from symptomatic gallstone disease and the costs per quality-adjusted life-year (QALY). RESULTS: Patients receiving UDCA prophylaxis were more likely to remain free from symptomatic gallstone disease (relative risk 1.06, 95 per cent c.i. 1.02 to 1.11; P = 0.002) compared with patients in the placebo group. The gain in QALYs, corrected for a baseline difference in health utility, was 0.047 (95 per cent bias-corrected and accelerated (Bca) c.i. 0.007 to 0.088) higher (P = 0.022). Differences in costs were –€356 (95 per cent Bca c.i. €–1573 to 761) from a healthcare perspective and –€1392 (–3807 to 917) from a societal perspective including out-of-pocket expenses and productivity loss, both statistically non-significant, in favour of UDCA prophylaxis. The probability of UDCA prophylaxis being cost-effective was at least 0.872. CONCLUSION: UDCA prophylaxis after RYGB in patients without gallstones before surgery was cost-effective.
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spelling pubmed-103646802023-07-31 Cost-effectiveness of ursodeoxycholic acid in preventing new-onset symptomatic gallstone disease after Roux-en-Y gastric bypass surgery Haal, Sylke Guman, Maimoena S S de Brauw, L Maurits Schouten, Ruben van Veen, Ruben N Fockens, Paul Gerdes, Victor E A Voermans, Rogier P Dijkgraaf, Marcel G W Br J Surg Original Article BACKGROUND: The aim was to evaluate the cost-effectiveness and cost–utility of ursodeoxycholic acid (UDCA) prophylaxis for the prevention of symptomatic gallstone disease after Roux-en-Y gastric bypass (RYGB) in patients without gallstones before surgery. METHODS: Data from a multicentre, double-blind, randomized placebo-controlled superiority trial were used. Patients scheduled for laparoscopic RYGB or sleeve gastrectomy were randomized to receive 900 mg UDCA or placebo for 6 months. Indicated by the clinical report, prophylactic prescription of UDCA was evaluated economically against placebo from a healthcare and societal perspective for the subgroup of patients without gallstones before surgery who underwent RYGB. Volumes and costs of in-hospital care, out-of-hospital care, out-of-pocket expenses, and productivity loss were assessed. Main outcomes were the costs per patient free from symptomatic gallstone disease and the costs per quality-adjusted life-year (QALY). RESULTS: Patients receiving UDCA prophylaxis were more likely to remain free from symptomatic gallstone disease (relative risk 1.06, 95 per cent c.i. 1.02 to 1.11; P = 0.002) compared with patients in the placebo group. The gain in QALYs, corrected for a baseline difference in health utility, was 0.047 (95 per cent bias-corrected and accelerated (Bca) c.i. 0.007 to 0.088) higher (P = 0.022). Differences in costs were –€356 (95 per cent Bca c.i. €–1573 to 761) from a healthcare perspective and –€1392 (–3807 to 917) from a societal perspective including out-of-pocket expenses and productivity loss, both statistically non-significant, in favour of UDCA prophylaxis. The probability of UDCA prophylaxis being cost-effective was at least 0.872. CONCLUSION: UDCA prophylaxis after RYGB in patients without gallstones before surgery was cost-effective. Oxford University Press 2022-08-18 /pmc/articles/PMC10364680/ /pubmed/35979609 http://dx.doi.org/10.1093/bjs/znac273 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Haal, Sylke
Guman, Maimoena S S
de Brauw, L Maurits
Schouten, Ruben
van Veen, Ruben N
Fockens, Paul
Gerdes, Victor E A
Voermans, Rogier P
Dijkgraaf, Marcel G W
Cost-effectiveness of ursodeoxycholic acid in preventing new-onset symptomatic gallstone disease after Roux-en-Y gastric bypass surgery
title Cost-effectiveness of ursodeoxycholic acid in preventing new-onset symptomatic gallstone disease after Roux-en-Y gastric bypass surgery
title_full Cost-effectiveness of ursodeoxycholic acid in preventing new-onset symptomatic gallstone disease after Roux-en-Y gastric bypass surgery
title_fullStr Cost-effectiveness of ursodeoxycholic acid in preventing new-onset symptomatic gallstone disease after Roux-en-Y gastric bypass surgery
title_full_unstemmed Cost-effectiveness of ursodeoxycholic acid in preventing new-onset symptomatic gallstone disease after Roux-en-Y gastric bypass surgery
title_short Cost-effectiveness of ursodeoxycholic acid in preventing new-onset symptomatic gallstone disease after Roux-en-Y gastric bypass surgery
title_sort cost-effectiveness of ursodeoxycholic acid in preventing new-onset symptomatic gallstone disease after roux-en-y gastric bypass surgery
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10364680/
https://www.ncbi.nlm.nih.gov/pubmed/35979609
http://dx.doi.org/10.1093/bjs/znac273
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