Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2015; 21(11): 3337-3343
Published online Mar 21, 2015. doi: 10.3748/wjg.v21.i11.3337
Economic and medical benefits of ultrasound screenings for gallstone disease
Hung-Ju Shen, Chung-Te Hsu, Tao-Hsin Tung
Hung-Ju Shen, Chung-Te Hsu, Tao-Hsin Tung, Cheng Hsin General Hospital, Taipei 112, Taiwan
Tao-Hsin Tung, Faculty of Public Health, School of Medicine, Fu-Jen Catholic University, Taipei 24205, Taiwan
Tao-Hsin Tung, Department of Nursing, Kang-Ning Junior College of Medical Care and Management, Taipei 114, Taiwan
Author contributions: Shen HJ, Hsu CT and Tung TH carried out the study and drafted the manuscript; Shen HJ participated in the design of the study and performed the statistical analysis; Tung TH conceived of the study, and participated in its design and coordination; all authors read and approved the final manuscript.
Supported by Grant from the National Science Council, No. NSC-98-2314-B-350-002-MY3 (in part).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tao-Hsin Tung, PhD, Cheng Hsin General Hospital, Shih-Pai, Taipei 112, Taiwan. ch2876@chgh.org.tw
Telephone: +886-2-28264400 Fax: +886-2-28264550
Received: September 23, 2014
Peer-review started: September 25, 2014
First decision: October 14, 2014
Revised: November 3, 2014
Accepted: December 8, 2014
Article in press: December 8, 2014
Published online: March 21, 2015

AIM: To investigate whether screening for gallstone disease was economically feasible and clinically effective.

METHODS: This clinical study was initially conducted in 2002 in Taipei, Taiwan. The study cohort total included 2386 healthy adults who were voluntarily admitted to a regional teaching hospital for a physical check-up. Annual follow-up screening with ultrasound sonography for gallstone disease continued until December 31, 2007. A decision analysis using the Markov Decision Model was constructed to compare different screening regimes for gallstone disease. The economic evaluation included estimates of both the cost-effectiveness and cost-utility of screening for gallstone disease.

RESULTS: Direct costs included the cost of screening, regular clinical fees, laparoscopic cholecystectomy, and hospitalization. Indirect costs represent the loss of productivity attributable to the patient’s disease state, and were estimated using the gross domestic product for 2011 in Taiwan. Longer time intervals in screening for gallstone disease were associated with the reduced efficacy and utility of screening and with increased cost. The cost per life-year gained (average cost-effectiveness ratio) for annual screening, biennial screening, 3-year screening, 4-year screening, 5-year screening, and no-screening was new Taiwan dollars (NTD) 39076, NTD 58059, NTD 72168, NTD 104488, NTD 126941, and NTD 197473, respectively (P < 0.05). The cost per quality-adjusted life-year gained by annual screening was NTD 40725; biennial screening, NTD 64868; 3-year screening, NTD 84532; 4-year screening, NTD 110962; 5-year screening, NTD 142053; and for the control group, NTD 202979 (P < 0.05). The threshold values indicated that the ultrasound sonography screening programs were highly sensitive to screening costs in a plausible range.

CONCLUSION: Routine screening regime for gallstone disease is both medically and economically valuable. Annual screening for gallstone disease should be recommended.

Keywords: Decision analysis, Gallstone disease, Economic evaluation, Evidence-based medicine, Screening

Core tip: The results of this economic evaluation of screening for gallstone disease indicated that routine ultrasound sonography screening is worthwhile. We recommend that the Chinese population is screened annually for gallstone disease, regardless of whether or not they have been diagnosed with gallstone disease in the past.