Cholecystectomy: costs and health-related quality of life: a comparison of two techniques
Departments of Surgery at 1 Motala Hospital, Motala, 2 Ryhov County Hospital, Jönköping, 3 Centre for Medical Technology Assessment, Linköping University, Linköping, Sweden
Background. Outcomes of previous health economic evaluations comparing minilaparotomy cholecystectomy and laparoscopic cholecystectomy have been inconsistent.
Objective. To compare costs for minilaparotomy cholecystectomy and laparoscopic cholecystectomy and to study changes in quality of life induced by these operations.
Design. Single-blind, randomized controlled trial, run from 1 March 1997 to 30 April 1999.
Setting. One university hospital and four non-university hospitals in Sweden.
Main measures. Cost and perceived health estimation according to the global quality of life instrument EuroQol-5D.
Results. Of 1719 cholecystectomy patients at five centres, 724 entered the trial and were treated with minilaparotomy cholecystectomy or laparoscopic cholecystectomy, 362 in each group. Total health care costs were less for minilaparotomy cholecystectomy than for laparoscopic cholecystectomy (median values US$2428 for minilaparotomy cholecystectomy versus US$2613 or US$3006 for laparoscopic cholecystectomy with 100 operations per year and reusable trocars or 50 operations per year and disposable trocars, respectively). There was no significant difference in total costs (including costs due to loss of production) between minilaparotomy cholecystectomy and laparoscopic cholecystectomy with 100 operations per year and reusable trocars in laparoscopic cholecystectomy (US$3731 versus US$3649, respectively). However, in calculations assuming 50 operations per year and disposable trocars in laparoscopic cholecystectomy, this technique was more expensive than minilaparotomy cholecystectomy (US$4042 versus US$3731). Health-related quality of life was slightly but significantly lower for the minilaparotomy cholecystectomy group 1 week after surgery. One month and 1 year postoperatively no difference between the randomized groups was found.
Conclusion. Total costs did not differ between minilaparotomy cholecystectomy and laparoscopic cholecystectomy with high-volume surgery and disposable trocars, whereas laparoscopic cholecystectomy was more expensive with fewer operations and disposable trocars. The gain in health-related quality of life with laparoscopic cholecystectomy compared with minilaparotomy cholecystectomy was small and of limited duration.
Keywords: cholecystectomy, health care costs, quality of life
Address reprint requests to Erik Nilsson, Department of Surgery, Umeå University Hospital, SE-90185 Umeå, Sweden. E-mail: Erik.Nilsson{at}lio.se
Accepted for publication July 21, 2004.
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