Análisis de costo efectividad de un programa preventivo de enfermedad vesicular en Chile / Cost effectiveness analysis of a screening program for gallbladder disease in Chile

ABSTRACT

Background. Chilean women have one of the highest mortality rates from gallstone disease in the world. There is no primary prevention for the disease and the benefits of prophylactic cholecystectomy in high risk groups have not been studied. Aim: To analyze the cost and effectiveness of a screening program for gallbladder disease in the Chilean women population. Methods. A decision analytic model is used to compare lifetime cost and effectiveness of standard care with three screening strategies. The first two strategies consider "universal ultrasound screening" for all women 40 years old and laparoscopic cholecystectomy for those with gallstones ("elective intervention") or with calculous ü3 cm ("high risk intervention"). The third strategy is based on "selective screening" for obese women. Results. The lifetime probability of a 40 years old Chilean woman of dying from gallbladder disease is reduced by 70 percent in the universal screening/elective intervention, by 63 percent in the high risk intervention and by 18 percent in the selective screening strategy. Her lifetime expectancy increases by 5.25, 4.64 and 1.24 months respectively. The incremental cost-effectiveness ratio of each screening strategy is US$ 180, US$ 147 and US$ 481 respectively. Conclusion. A screening program for gallbladder disease in a high risk population achieves significant benefits at a low incremental cost and acceptable cost-effectiveness