Health Economic Assessment On ERCP And Open Abdomen Operation In Treating Common Bile Duct Stone

Objective: With the further development of health care reform, people not only concerns about the effectiveness and safety of medical service, but pays more and more attention to its cost. ERCP has been recognized as effective and safe treatment for the surgical treatment of common bile duct stones, while endoscopic lithotomy also found its extensive application in treating the disease. For the first time, this research conducted cost-utility analysis between endoscopic and open abdomen operation in treating Common Bile Duct Stones within the demesitc environment. By the analysis, we aim to inform clinical practicers as well as hospital managers on how to promote the quality of health care in patients with common bile duct stones, and to provide empirical information to insurers as well as policy-makers on how to curtail medical expenditures.Methods: Based on patients'quality of life obtained by standard instrument, we conducted a cost-utility analysis, detailed as follows:1 Determination of quality of life From May 2010 to January 2011, the 216 patients diagnosed with common bile duct stones at a large comprehensive hospital were divided into two groups, namely, routine ERCP group (135) and Open abdomen operation group (81). The patients were recruited accord- ing to ASA Classification. The two groups have consistent demographic indicators, such as age, sex, etc. Questionnaires were filled by all patients with common bile duct stones before and 2 and 6 weeks after the surgery. Eighty-eight of 216 patients completed all 3 follow-up assessments, including 118 patients in the ERCP surgery group and 73 patients in the Open Abdomen Operation group. The other 25 patients were lost in six weeks after surgery.2 Fee collection methodsThe patients'direct medical costs during hospitalization were divided into six parts:①drugs;②inspection fees: including radiology, testing, special examination, endoscopy, X-ray fees, ECG cardiac function, etc.;③treatment costs: including hospitalization, treatment, care, blood transfusions, dressing fees, materials at their own expense, the sick room treatment, materials, etc ;④surgery: including anesthesia charges, hand material costs, surgery, ECG, oxygen Fees;⑤bed fee;⑥Other: including meals and so on. Indirect costs refer to the disease caused economic losses to society, including family members of patients and their loved ones lost during the illness in its value of labor, with the present value method. Because the patient can not accurately calculate the indirect costs, the cost of hospitalization in patients taking only direct medical costs during the calculation.3 Cost - utility analysisUse of quantitative indicators of quality of life index GIQLI . Two groups of patients on quality of life assessment, and the results were compared; hospital stay and hospital costs can be compared. Using multiple stepwise regressions analyzes their influence factors. Last obtain cost-utility ratios in order to assess the economic assessment.Results:1 Compare the quality of life with the GIQLI index Endoscopic group: The mean preoperative, and 2 and 6 weeks preoperative GIQLI indices were 103.0, 113.4 and 120.7; Open abdomen group: The mean preoperative, and 2 and 6 weeks preoperative GIQLI indices were 99.7, 107.2 and 116.9;2 The average length of stay compared Endoscopic group: mean hospital stay (8.8±6.5) days; Open abdomen group: mean hospital stay (13.9±6.7) days;3 The average hospital cost comparison Endoscopic group: the average hospital cost (22460.8±13015.8) yuan; Open abdomen group: the average hospital cost (22915.9±9469.2) yuan;4 Compare the cost - utility ratios(CUR) values and the incremental cost utility ratio,(ICUR) Endoscopic group: CUR1 =27,192.89,ICUR1 =203,008.28; Open abdomen group:CUR2 =28,250.09,ICUR2 =243,138.99Conclusion:1 Compared with the traditional Open Abdomen Operation, common bile duct stones after routine ERCP are more conducive to improving quality of life of patients.2 Compared with the traditional Open Abdomen Operation, common bile duct stones routine ERCP is more low cost and the average length of stay is significantly shortened.3 The subject of the establishment of the cost-utility analysis, the program can easily calculate the cost utility of two surgical values. Compared with Open Abdomen Operation in patients, ERCP surgery in patients can have a lower cost of hospitalization, recovery sooner and get higher quality of life.