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Cost-effectiveness of trans-abdominal ultrasound for gallbladder cancer surveillance in patients with gallbladder polyps less than 10 mm in the United Kingdom

Julia Lowin, Berni Sewell, Matthew Prettyjohns, Angela Farr Orcid Logo, Kieran G Foley Orcid Logo

British Journal of Radiology, Volume: 98, Issue: 1169, Pages: 693 - 700

Swansea University Authors: Julia Lowin, Berni Sewell, Angela Farr Orcid Logo

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DOI (Published version): 10.1093/bjr/tqaf024

Abstract

Objectives: Gallbladder polyps (GBPs) are commonly detected with trans-abdominal ultrasound (TAUS). Gallbladder cancer (GBC) is associated with GBPs but the risk of malignancy is low. International guidelines recommend ultrasound surveillance (USS) in selected cases of GBPs <10 mm, with cholecyst...

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Published in: British Journal of Radiology
ISSN: 0007-1285 1748-880X
Published: Oxford University Press (OUP) 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa68992
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Gallbladder cancer (GBC) is associated with GBPs but the risk of malignancy is low. International guidelines recommend ultrasound surveillance (USS) in selected cases of GBPs &lt;10 mm, with cholecystectomy advised if the polyp size increases. USS (including potential cholecystectomies) is resource intense. We evaluated the costs and potential cost-effectiveness of USS in a theoretical UK patient cohort with GBPs. Methods: A health economic model mapped expected management pathways over 2 years for 1000 GBP patients with and without USS, stratified by the initial size of GBP (&lt;6 mm and 6&#x2013;9 mm). We estimated USS resource and costs under alternate referral thresholds for cholecystectomy. Clinical data were extracted from a large-scale cohort study. TAUS and cholecystectomy costs were based on NHS tariffs. GBC costs were estimated from the literature. Outcomes included USS costs, expected numbers of GBC, and incremental cost for each case of GBC avoided. Results: The 2-year additional cohort costs of USS (n&#x2009;=&#x2009;number of cholecystectomies) were estimated between &#xA3;213&#x2009;441 (n&#x2009;=&#x2009;50) and &#xA3;750&#x2009;045 (n&#x2009;=&#x2009;253) in GBPs &lt;6 mm and between &#xA3;420&#x2009;275 (n&#x2009;=&#x2009;165) and &#xA3;531&#x2009;297 (n&#x2009;=&#x2009;207) in GBPs 6&#x2013;9 mm, balanced against avoidance of 1.3 (&lt;6 mm) and 8.7 (6&#x2013;9 mm) cases of GBC. Model findings were robust to plausible changes in inputs. Conclusions: Using published data, we demonstrated that, in patients with GBPs &lt;10 mm, the costs of USS to avoid GBC outweigh potential GBC cost offsets and would result in high rates of cholecystectomy. Additional evidence is needed to establish the formal cost-effectiveness of GBP USS in the UK. Advances in knowledge: &#x2022; We developed a health economic model, based on published data, to evaluate the cost-effectiveness of guideline-recommended ultrasound surveillance (USS) in patients with gallbladder polyps measuring less than 10 mm in the UK. &#x2022; The analysis provides a transparent platform to explore potential numbers of trans-abdominal ultrasound studies and cholecystectomies that might be expected if USS protocols are adhered to and discovers important gaps in current evidence that could be filled by additional targeted research.</abstract><type>Journal Article</type><journal>British Journal of Radiology</journal><volume>98</volume><journalNumber>1169</journalNumber><paginationStart>693</paginationStart><paginationEnd>700</paginationEnd><publisher>Oxford University Press (OUP)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0007-1285</issnPrint><issnElectronic>1748-880X</issnElectronic><keywords>gallbladder polyp, gallbladder cancer, ultrasound, cost-effectiveness</keywords><publishedDay>1</publishedDay><publishedMonth>5</publishedMonth><publishedYear>2025</publishedYear><publishedDate>2025-05-01</publishedDate><doi>10.1093/bjr/tqaf024</doi><url/><notes/><college>COLLEGE NANME</college><department>Health and Social Care School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HSOC</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>Health Technology Wales commissioned Swansea Centre for Health Economics (SCHE) to conduct this economic analysis as part of a Service Level Contractual Agreement to provide health economics support. Funding for the reporting of the work was provided through Health and Care Economics Cymru (HCEC), which is supported by Health and Care Research Wales funding, via the Welsh Government. K.G.F. was supported by research funding from Health and Care Research Wales (NHS.RTA-19-09) and Velindre Cancer Centre during this work.</funders><projectreference/><lastEdited>2025-04-25T12:28:02.6745809</lastEdited><Created>2025-02-28T12:29:51.8388784</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Health and Social Care - Public Health</level></path><authors><author><firstname>Julia</firstname><surname>Lowin</surname><order>1</order></author><author><firstname>Berni</firstname><surname>Sewell</surname><order>2</order></author><author><firstname>Matthew</firstname><surname>Prettyjohns</surname><order>3</order></author><author><firstname>Angela</firstname><surname>Farr</surname><orcid>0000-0002-2087-9310</orcid><order>4</order></author><author><firstname>Kieran G</firstname><surname>Foley</surname><orcid>0000-0002-1299-1759</orcid><order>5</order></author></authors><documents><document><filename>68992__34110__47c2429aa6a041c896bfedee7175fe67.pdf</filename><originalFilename>68992.VOR.pdf</originalFilename><uploaded>2025-04-25T12:25:34.1400607</uploaded><type>Output</type><contentLength>1079885</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; The Author(s) 2025. Published by Oxford University Press on behalf of the British Institute of Radiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (CC BY).</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>https://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2025-04-25T12:28:02.6745809 v2 68992 2025-02-28 Cost-effectiveness of trans-abdominal ultrasound for gallbladder cancer surveillance in patients with gallbladder polyps less than 10 mm in the United Kingdom a9897f4e67e285093fefafcb1c954364 Julia Lowin Julia Lowin true false f6a4af2cfa4275d2a8ebba292fa14421 Berni Sewell Berni Sewell true false ab00dbaa888f32b41b07ef223d0e2987 0000-0002-2087-9310 Angela Farr Angela Farr true false 2025-02-28 HSOC Objectives: Gallbladder polyps (GBPs) are commonly detected with trans-abdominal ultrasound (TAUS). Gallbladder cancer (GBC) is associated with GBPs but the risk of malignancy is low. International guidelines recommend ultrasound surveillance (USS) in selected cases of GBPs <10 mm, with cholecystectomy advised if the polyp size increases. USS (including potential cholecystectomies) is resource intense. We evaluated the costs and potential cost-effectiveness of USS in a theoretical UK patient cohort with GBPs. Methods: A health economic model mapped expected management pathways over 2 years for 1000 GBP patients with and without USS, stratified by the initial size of GBP (<6 mm and 6–9 mm). We estimated USS resource and costs under alternate referral thresholds for cholecystectomy. Clinical data were extracted from a large-scale cohort study. TAUS and cholecystectomy costs were based on NHS tariffs. GBC costs were estimated from the literature. Outcomes included USS costs, expected numbers of GBC, and incremental cost for each case of GBC avoided. Results: The 2-year additional cohort costs of USS (n = number of cholecystectomies) were estimated between £213 441 (n = 50) and £750 045 (n = 253) in GBPs <6 mm and between £420 275 (n = 165) and £531 297 (n = 207) in GBPs 6–9 mm, balanced against avoidance of 1.3 (<6 mm) and 8.7 (6–9 mm) cases of GBC. Model findings were robust to plausible changes in inputs. Conclusions: Using published data, we demonstrated that, in patients with GBPs <10 mm, the costs of USS to avoid GBC outweigh potential GBC cost offsets and would result in high rates of cholecystectomy. Additional evidence is needed to establish the formal cost-effectiveness of GBP USS in the UK. Advances in knowledge: • We developed a health economic model, based on published data, to evaluate the cost-effectiveness of guideline-recommended ultrasound surveillance (USS) in patients with gallbladder polyps measuring less than 10 mm in the UK. • The analysis provides a transparent platform to explore potential numbers of trans-abdominal ultrasound studies and cholecystectomies that might be expected if USS protocols are adhered to and discovers important gaps in current evidence that could be filled by additional targeted research. Journal Article British Journal of Radiology 98 1169 693 700 Oxford University Press (OUP) 0007-1285 1748-880X gallbladder polyp, gallbladder cancer, ultrasound, cost-effectiveness 1 5 2025 2025-05-01 10.1093/bjr/tqaf024 COLLEGE NANME Health and Social Care School COLLEGE CODE HSOC Swansea University Another institution paid the OA fee Health Technology Wales commissioned Swansea Centre for Health Economics (SCHE) to conduct this economic analysis as part of a Service Level Contractual Agreement to provide health economics support. Funding for the reporting of the work was provided through Health and Care Economics Cymru (HCEC), which is supported by Health and Care Research Wales funding, via the Welsh Government. K.G.F. was supported by research funding from Health and Care Research Wales (NHS.RTA-19-09) and Velindre Cancer Centre during this work. 2025-04-25T12:28:02.6745809 2025-02-28T12:29:51.8388784 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health Julia Lowin 1 Berni Sewell 2 Matthew Prettyjohns 3 Angela Farr 0000-0002-2087-9310 4 Kieran G Foley 0000-0002-1299-1759 5 68992__34110__47c2429aa6a041c896bfedee7175fe67.pdf 68992.VOR.pdf 2025-04-25T12:25:34.1400607 Output 1079885 application/pdf Version of Record true © The Author(s) 2025. Published by Oxford University Press on behalf of the British Institute of Radiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (CC BY). true eng https://creativecommons.org/licenses/by/4.0/
title Cost-effectiveness of trans-abdominal ultrasound for gallbladder cancer surveillance in patients with gallbladder polyps less than 10 mm in the United Kingdom
spellingShingle Cost-effectiveness of trans-abdominal ultrasound for gallbladder cancer surveillance in patients with gallbladder polyps less than 10 mm in the United Kingdom
Julia Lowin
Berni Sewell
Angela Farr
title_short Cost-effectiveness of trans-abdominal ultrasound for gallbladder cancer surveillance in patients with gallbladder polyps less than 10 mm in the United Kingdom
title_full Cost-effectiveness of trans-abdominal ultrasound for gallbladder cancer surveillance in patients with gallbladder polyps less than 10 mm in the United Kingdom
title_fullStr Cost-effectiveness of trans-abdominal ultrasound for gallbladder cancer surveillance in patients with gallbladder polyps less than 10 mm in the United Kingdom
title_full_unstemmed Cost-effectiveness of trans-abdominal ultrasound for gallbladder cancer surveillance in patients with gallbladder polyps less than 10 mm in the United Kingdom
title_sort Cost-effectiveness of trans-abdominal ultrasound for gallbladder cancer surveillance in patients with gallbladder polyps less than 10 mm in the United Kingdom
author_id_str_mv a9897f4e67e285093fefafcb1c954364
f6a4af2cfa4275d2a8ebba292fa14421
ab00dbaa888f32b41b07ef223d0e2987
author_id_fullname_str_mv a9897f4e67e285093fefafcb1c954364_***_Julia Lowin
f6a4af2cfa4275d2a8ebba292fa14421_***_Berni Sewell
ab00dbaa888f32b41b07ef223d0e2987_***_Angela Farr
author Julia Lowin
Berni Sewell
Angela Farr
author2 Julia Lowin
Berni Sewell
Matthew Prettyjohns
Angela Farr
Kieran G Foley
format Journal article
container_title British Journal of Radiology
container_volume 98
container_issue 1169
container_start_page 693
publishDate 2025
institution Swansea University
issn 0007-1285
1748-880X
doi_str_mv 10.1093/bjr/tqaf024
publisher Oxford University Press (OUP)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
document_store_str 1
active_str 0
description Objectives: Gallbladder polyps (GBPs) are commonly detected with trans-abdominal ultrasound (TAUS). Gallbladder cancer (GBC) is associated with GBPs but the risk of malignancy is low. International guidelines recommend ultrasound surveillance (USS) in selected cases of GBPs <10 mm, with cholecystectomy advised if the polyp size increases. USS (including potential cholecystectomies) is resource intense. We evaluated the costs and potential cost-effectiveness of USS in a theoretical UK patient cohort with GBPs. Methods: A health economic model mapped expected management pathways over 2 years for 1000 GBP patients with and without USS, stratified by the initial size of GBP (<6 mm and 6–9 mm). We estimated USS resource and costs under alternate referral thresholds for cholecystectomy. Clinical data were extracted from a large-scale cohort study. TAUS and cholecystectomy costs were based on NHS tariffs. GBC costs were estimated from the literature. Outcomes included USS costs, expected numbers of GBC, and incremental cost for each case of GBC avoided. Results: The 2-year additional cohort costs of USS (n = number of cholecystectomies) were estimated between £213 441 (n = 50) and £750 045 (n = 253) in GBPs <6 mm and between £420 275 (n = 165) and £531 297 (n = 207) in GBPs 6–9 mm, balanced against avoidance of 1.3 (<6 mm) and 8.7 (6–9 mm) cases of GBC. Model findings were robust to plausible changes in inputs. Conclusions: Using published data, we demonstrated that, in patients with GBPs <10 mm, the costs of USS to avoid GBC outweigh potential GBC cost offsets and would result in high rates of cholecystectomy. Additional evidence is needed to establish the formal cost-effectiveness of GBP USS in the UK. Advances in knowledge: • We developed a health economic model, based on published data, to evaluate the cost-effectiveness of guideline-recommended ultrasound surveillance (USS) in patients with gallbladder polyps measuring less than 10 mm in the UK. • The analysis provides a transparent platform to explore potential numbers of trans-abdominal ultrasound studies and cholecystectomies that might be expected if USS protocols are adhered to and discovers important gaps in current evidence that could be filled by additional targeted research.
published_date 2025-05-01T05:22:19Z
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