The results of the economic evaluation suggest that , on average , the surgery strategy costs £ 1236 more per patient than the conservative management strategy but was , on average , more effective .
An increase in the number of people requiring surgery while treated conservatively corresponded to a reduction in the cost-effectiveness of the conservative strategy .
The results of this assessment indicate that cholecystectomy is still the treatment of choice for many symptomatic people .
However , approximately half of the people in the observation group did not require surgery or suffer complications in the long term indicating that a conservative therapeutic approach may represent a valid alternative to surgery in this group of people .
BACKGROUND Approximately 10 - 15 % of the adult population suffer from gallstone disease , cholelithiasis , with more women than men being affected .
Cholecystectomy is the treatment of choice for people who present with biliary pain or acute cholecystitis and evidence of gallstones .
However , some people do not experience a recurrence after an initial episode of biliary pain or cholecystitis .
As most of the current research focuses on the surgical management of the disease , less attention has been dedicated to the consequences of conservative management .
OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of  cholecystectomy  compared with observation/conservative management in people presenting with uncomplicated symptomatic gallstones ( biliary pain ) or cholecystitis .
Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones.
BACKGROUND After cholecystectomy for symptomatic gallstone disease 20%-30 % of the patients continue to have abdominal pain . The aim of this study was to investigate whether preoperative variables could predict the symptomatic outcome after cholecystectomy . METHODS One hundred and two patients were referred to elective cholecystectomy  in a prospect i ve study . Median age was 45 years ; range , 20 - 81 years . A preoperative question naire on pain , symptoms , and history was completed , and the questions on pain and symptoms were repeated 1 year postoperatively . Preoperative cholescintigraphy and sonography evaluated gallbladder motility , gallstones , and gallbladder volume . Preoperative variables in patients with or without postcholecystectomy pain were compared statistically , and significant variables were combined in a logistic regression model to predict the postoperative outcome . RESULTS Eighty patients completed all question naires . Twenty-one patients continued to have abdominal pain after the operation . Patients with pain 1 year after cholecystectomy were characterized by the preoperative presence of a high dyspepsia score , ' irritating ' abdominal pain , and an introverted personality and by the absence of ' agonizing ' pain and of symptoms coinciding with pain ( P < 0.000001 ) . In a constructed logistic regression model 15 of 18 predicted patients had postoperative pain ( PVpos = 0.83 ) . Of 62 patients predicted as having no pain postoperatively , 56 were pain-free ( PVneg = 0.90 ) . Overall accuracy was 89 % . CONCLUSION From this prospect i ve study a model based on preoperative symptoms was developed to predict postcholecystectomy pain . Since intra study reclassification may give too optimistic results , the model should be vali date d in future studies
The results of the economic evaluation suggest that , on average , the surgery strategy costs £ 1236 more per patient than the conservative management strategy but was , on average , more effective .
An increase in the number of people requiring surgery while treated conservatively corresponded to a reduction in the cost-effectiveness of the conservative strategy .
The results of this assessment indicate that cholecystectomy is still the treatment of choice for many symptomatic people .
However , approximately half of the people in the observation group did not require surgery or suffer complications in the long term indicating that a conservative therapeutic approach may represent a valid alternative to surgery in this group of people .
BACKGROUND Approximately 10 - 15 % of the adult population suffer from gallstone disease , cholelithiasis , with more women than men being affected .
Cholecystectomy is the treatment of choice for people who present with biliary pain or acute cholecystitis and evidence of gallstones .
However , some people do not experience a recurrence after an initial episode of biliary pain or cholecystitis .
As most of the current research focuses on the surgical management of the disease , less attention has been dedicated to the consequences of conservative management .
OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of  cholecystectomy  compared with observation/conservative management in people presenting with uncomplicated symptomatic gallstones ( biliary pain ) or cholecystitis .