Gallbladder Cancer: Is It Time to Modify the Explicit Health Guarantees (GES) Program?
Chile has guaranteed gallbladder removal for people aged 35 to 49 with gallstones since 2006 to prevent gallbladder cancer; this review of official data finds deaths falling but already falling before the programme, and uptake not matching the regions where the cancer is commonest.
Overview
Retrospective analysis of official Chilean Ministry of Health and National Statistics Institute data on the GES preventive cholecystectomy programme, which since 2006 has included cholelithiasis in patients aged 35 to 49 with cholecystectomy as guaranteed treatment. Since inception 284,139 notifications had been issued to patients in that age band with gallstones, correlating with cholecystectomies performed under the programme. Standardised gallbladder cancer mortality has fallen over two decades, including before the programme began. Incidence varies across the country and high-incidence areas are not always the areas with most notifications. The authors conclude the programme should be modified to direct resources to patients in high-incidence areas with known risk factors.
- 284,139 GES notifications issued since 2006 to patients aged 35 to 49 with gallstones.
- Standardised gallbladder cancer mortality has decreased over two decades, including before the programme was implemented.
- High-incidence areas are not always the areas with high notification rates.
The only national prophylactic cholecystectomy programme in the world has run for nearly twenty years without a design that can show whether it works. Targeting by region and risk, and building in an evaluation, is the obvious next step.
- Ecological analysis of routine data; no counterfactual.
- Spanish-language article; the abstract is the source used here.
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