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COST-EFFECTIVENESS ANALYSIS OF LAPAROSCOPIC VERSUS MINILAPAROTOMY CHOLECYSTECTOMY FOR GALLSTONE DISEASE

A Randomized Trial

Published online by Cambridge University Press:  20 May 2002

Anurag Srivastava
Affiliation:
All India Institute of Medical Sciences
Guddanti Srinivas
Affiliation:
All India Institute of Medical Sciences
Mahesh Chandra Misra
Affiliation:
All India Institute of Medical Sciences
Chandrakant S. Pandav
Affiliation:
All India Institute of Medical Sciences
Vuthaluru Seenu
Affiliation:
All India Institute of Medical Sciences
Amit Goyal
Affiliation:
All India Institute of Medical Sciences

Abstract

Objective: To evaluate the total cost of minilaparotomy cholecystectomy (MC) and laparoscopic cholecystectomy (LC) and perform a cost-effectiveness (CE) analysis.

Methods: One hundred adult subjects with painful gallstone disease were randomized: 59 cases for LC and 41 cases for MC. Patients with gallstones shown on ultrasound with normal common bile duct and no history of icterus were included after an informed consent. Cases with acute cholecystitis and raised alkaline phosphatase were excluded. LC was performed using CO2 insufflation and a Storz 2D video camera. MC was done by transverse rectus cutting incision. Outcome was coded as success or failure. Success was defined as operation without injury to bile duct, viscera or vessels, minimal pain and discomfort at 4 weeks, no wound infection up to 4 weeks, and resumption of work within 2 weeks of operation. The total cost of each case included cost of investigations, cost of disposable articles for operation, cost of drugs, cost of hospital stay, and cost of operation including anesthesia. LC and MC were done with reusable instruments. A “societal viewpoint” has been taken in the cost calculations.

Results: There were 50/59 successful outcomes in LC and 15/40 outcomes in MC group. Total cost for LC was 386,769 rupees (Rs) and for MC was Rs 205,041. CE in LC was Rs 7,735 and in MC was Rs 13,669. Incremental CE ratio comparing LC with MC was 3,028.33.

Conclusion: LC is a more cost-effective method for treatment of gallstone disease.

Type
Research Article
Copyright
© 2001 Cambridge University Press

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COST-EFFECTIVENESS ANALYSIS OF LAPAROSCOPIC VERSUS MINILAPAROTOMY CHOLECYSTECTOMY FOR GALLSTONE DISEASE
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