The true cost of gallstone disease

INTRODUCTION: Gallstone related disease accounts for a large expenditure in the NHS. The aim of this study was to review the events and costs of the patient journey to treatment, and propose guidelines to provide an efficient streamlined service. PATIENTS AND METHODS: All cholecystectomies performed in one unit in 2009 were reviewed. The cost of all investigations and procedures performed was obtained from the Department of Health website. The individual cost was calculated for each patient. Results were expressed as mean (±SD) and compared using ANOVA. RESULTS: 132 patients (31 male) were reviewed with an overall age was 45.3 years (±15.1). Overall cost from referral to discharge was £4697 (±2007) per patient, ranging from £3406 to £12011. The largest proportion was contributed by surgery at £2849 (±414), followed by inpatient costs at £1527 (±1322). Pre-operative outpatient consultations were £174 (±144), supplemented by at least one ultrasound (£81±29). Additional imaging was required for only a minority. All blood tests involved in overall care contributed little to the total at £27 (±26). Patients who initially presented as an inpatient had an overall larger cost (£6112±1888 vs. £5097±1607; p=0.004). This difference was largely due to inpatient costs (£2611±1629 vs. £1194±1009; p<0.0001) and not the cost of surgery (p=0.29). Patients who were imaged in primary care prior to referral also had a lower overall cost (£4636±1343 vs. £5697±1804; p=0.0005). This was also due to inpatient costs (£1076±876 vs. £1740±1459; p=0.004) and not the actual surgery costs (p=0.36). Only 39 were reviewed post-operatively, adding £38±69 to the overall cohort costs. CONCLUSION: Emergency presentation and repeat admissions result in higher inpatient costs and should be avoided. Reduced delay to elective surgery through active participation by primary care needs to be encouraged.