OBJECTIVES: Digital cholangioscope SpyDiscover^TM has emerged as a innovative therapeutical alternative for the treatment of choledocholithiasis during laparoscopic cholecystectomy in a one-stage approach (Laparoscopic Common Bile Duct Exploration, LCBDE) versus standard of care, two-stage approach requiring Endoscopic Retrograde Cholangiopancreatography (ERCP). In that context, the following study aims to estimate the potential direct medical cost savings in the Spanish public setting resulting from the adoption of the therapy compared to the standard two-stage approach, considering both the transcystic and transcholedochal therapeutic approaches.

METHODS: A static decision tree model was utilized to estimate the budget impact over a one-year time horizon from a payer's perspective. Model inputs were categorized into device acquisition costs, intervention costs, and complications costs to compare the one-stage approach versus the two-stage approach, as well as the transcystic and transcholedochal approaches, depending on the technology used (reusable or single-use scope). Parametric uncertainty was assessed using a one-way sensitivity analysis.

RESULTS: Introduction of SpyDiscover^TM in non-LCBDE adopters settings results in a total cost savings of 2.756€ per case compared to two-stages approach. Performing the transcystic approach for LCBDE with SpyDiscover results in a total cost savings of 668€ per case compared to the reusable scope. Capital costs and Hospital cost were the most influential parameters of the model. The +/- 20% variation in model input parameters still yielded cost saving results.

CONCLUSIONS: The adoption of the digital cholangioscope SpyDiscover^TM for choledocholithiasis treatment during laparoscopic cholecystectomy in a one-stage approach emerges as a compelling cost-saving measure versus current standard techniques, notably in the preferred transcystic clinical approach. Its significant reduction in complications further solidifies its value as a cost-effective solution.