Meta‐analysis of the cost‐effectiveness of early versus delayed cholecystectomy for acute cholecystitis

BACKGROUND: Acute calculous cholecystitis (ACC) is a common disease across the world and is associated with significant socioeconomic costs. Although contemporary guidelines support the role of early laparoscopic cholecystectomy (ELC), there is significant variation among units adopting it as standard practice. There are many resource implications of providing a service whereby cholecystectomies for acute cholecystitis can be performed safely. METHODS: Studies that incorporated an economic analysis comparing early with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis were identified by means of a systematic review. A meta‐analysis was performed on those cost evaluations. The quality of economic valuations contained therein was evaluated using the Quality of Health Economic Studies (QHES) analysis score. RESULTS: Six studies containing cost analyses were included in the meta‐analysis with 1128 patients. The median healthcare cost of ELC versus DLC was €4400 and €6004 respectively. Five studies had adequate data for pooled analysis. The standardized mean difference between ELC and DLC was −2·18 (95 per cent c.i. −3·86 to −0·51; P = 0·011; I (2) = 98·7 per cent) in favour of ELC. The median QHES score for the included studies was 52·17 (range 41–72), indicating overall poor‐to‐fair quality. CONCLUSION: Economic evaluations within clinical trials favour ELC for ACC. The limited number and poor quality of economic evaluations are noteworthy.