Randomised controlled trial of cost-effectiveness of lithotripsy and open cholecystectomy as treatments for gallbladder stones.
Inpatient extracorporeal shockwave lithotripsy for treatment of gallbladder stones has not previously been compared with open cholecystectomy in terms of cost-effectiveness. In a randomised controlled trial, 163 patients, stratified by gallstone bulk (over 4 cm3 or not), were randomised to lithotripsy or cholecystectomy (38 large-bulk and 27 small-bulk cholecystectomy; 37 large-bulk and 61 small-bulk lithotripsy) and followed up for 1 year. Both treatments gave significant health gains in terms of a reduction in episodes of biliary pain, improved perceived health status, and symptom relief, but few differences between treatments were found. There was some evidence that biliary-pain episodes were less severe after cholecystectomy. Cholecystectomy patients also had greater improvements in mean health gain for three related symptoms: vomiting, feeling sick, and fatty-food upset. However, there were no differences between groups in perceived health status. Among lithotripsy patients, health gain was not related to stone clearance. Lithotripsy was more expensive than cholecystectomy, principally because of the costs of the inpatient stay and adjuvant bile-salt therapy. Conventional lithotripsy appears at least as cost-effective as cholecystectomy for patients with small-bulk stones but less cost-effective for those with large-bulk stones. To some extent treatment choice can be guided by patient preference.
Department of Public Health Medicine, Sheffield University Medical School, UK.
J P
JP
Nicholl
J E
JE
Brazier
P C
PC
Milner
L
L
Westlake
B
B
Kohler
B T
BT
Williams
B
B
Ross
E
E
Frost
A G
AG
Johnson
D000328:Adult; D000368:Aged; D001647:Bile Acids and Salts / Q000627:therapeutic use; D001660:Biliary Tract Diseases / Q000628:therapy; D002763:Cholecystectomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D002769:Cholelithiasis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D003085:Colic / Q000628:therapy; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D006304:Health Status; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome
D001647:Bile Acids and Salts