A population sample of 2464 persons between 20 and 70 years of age was invited to participate in a screening study designed for establishing gallstone prevalence rates. The diagnosis of gallstones was based on an ultrasonographic examination. The overall response rate after the primary invitation was 55.6%. Gallbladder stones were diagnosed in 300 persons, giving a crude prevalence of 21.9%. Total age-adjusted prevalence rates were 17.7% in men and 21.2% in women. From age group 20-29 years to age group 60-69 years the prevalence rates increased from 4.9% to 37.0% in men and from 6.0% to 41.3% in women. The age- and sex-specific rates are comparable to those of more recent studies from Scandinavia but are markedly higher than prevalence rates in a Norwegian study from 1960.
A population sample of 2464 persons between 20 and 70 years of age was included in a screening study designed for establishing gallstone prevalence rates and the frequency distribution of abdominal symptoms in groups with and without gallstone(s). The response rate was 55.6%. Two hundred and eighty-five persons had unoperated gallstone disease, as diagnosed by ultrasound. They were compared with 1044 individuals without ultrasonographically detected gallstones. The frequency distribution of epigastric and/or substernal burning, upper or lower abdominal pain, intolerance to fatty food, nausea and/or vomiting, and jaundice was similar for the two groups. Of the screened population 35% have had to see a physician for abdominal symptoms, with no difference between the two groups. In conclusion, abdominal symptoms are common in individuals with and without gallstone(s), but no differences were found in frequency distribution of symptoms between the groups. Consequently, gallstone disease is asymptomatic in the vast majority of individuals. The high proportion of abdominal symptoms in the population with gallstone(s) combined with increasing ultrasonographic activities may lead to unjustifiable cholecystectomies.
Unexpectedly, only a minority of persons examined with ultrasonography had present day gallstones without any obvious explanation for this low figure. The rate of cholecystectomy was low in a conservative setting and no adverse events could be ascertained from such a policy.
Objective:The aim of this work was to estimate cost-effectiveness of five common
procedures for varicose vein surgery (high ligation and stripping,
radiofrequency ablation, endovenous laser ablation, steam vein
sclerosis and cyanoacrylate glue) in a
Norwegian setting from both a societal and a healthcare payer
perspective.Design:Cost-effectiveness analysis using decision tree modelling.Methods:A structured literature search was conducted to estimate the clinical
effectiveness and the rate of complications in the five methods. Data on
costs and health-related quality of life associated with varicose vein
disease were also collected. With the aid of an expert panel, a structured
decision tree was developed. A 1-year perspective was modelled, and a
variety of common complications were included. Monte Carlo simulation was
used for probabilistic sensitivity analyses.Results:The laser ablation strategy was the most cost-effective
option from a societal perspective, with an incremental cost-effectiveness
ratio of €8448 compared to a no-treatment alternative, and had a 42%
probability of being cost-effective using the Norwegian willingness-to-pay
threshold of €59,880. From a healthcare payer perspective, however, the
steam vein sclerosis strategy was the most
cost-effective with an incremental cost-effectiveness ratio of €4072
compared to a no-treatment alternative, and this strategy had a 50%
probability of being cost-effective.Conclusion:Results from this study did depend upon the perspective chosen for analyses.
Although recent endovenous surgical procedures (including laser
ablation and steam vein sclerosis) provide
clinically effective treatment for advanced, symptomatic varicose vein
disease, availability of high-level data is currently limiting the
cost-effectiveness analyses.
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