title: Cost-effectiveness of extracorporeal shock-wave lithotripsy versus cholecystectomy for symptomatic gallstones.
abstract: To evaluate the cost-effectiveness of extracorporeal shock-wave lithotripsy vs. cholecystectomy for symptomatic gallstones, a model was constructed that projects charges and survival for both treatments. For a 45-year-old woman with one small stone, treatment with extracorporeal shock-wave lithotripsy rather than cholecystectomy is projected to result in an average gain of only 3 days of life and an average increase in direct medical charges of $1729 over 5 years of follow-up. The resulting marginal cost-effectiveness of extracorporeal shock-wave lithotripsy vs. cholecystectomy is $216,000 of extra charges per year of life gained with extracorporeal shock-wave lithotripsy. Extracorporeal shock-wave lithotripsy is projected to be much more cost-effective for elderly than for young patients (10-20-fold difference), but considerably less cost-effective for multiple stones than a single stone (2-4-fold difference), and less cost-effective for women than men (twofold difference). Adjusting for effects of morbidity on quality of life, extracorporeal shock-wave lithotripsy is projected to have slightly better quality-adjusted survival than cholecystectomy for the small subset of patients with one stone (by 8 to 43 days at 5 years) but not for young patients with multiple stones. It is concluded that decisions about appropriate use of extracorporeal shock-wave lithotripsy should consider the effects of patient characteristics on clinical and economic outcomes.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: E B
authors.initials: EB
authors.lastname: Bass
authors.forename: E P
authors.initials: EP
authors.lastname: Steinberg
authors.forename: H A
authors.initials: HA
authors.lastname: Pitt
authors.forename: G P
authors.initials: GP
authors.lastname: Saba
authors.forename: K D
authors.initials: KD
authors.lastname: Lillemoe
authors.forename: D R
authors.initials: DR
authors.lastname: Kafonek
authors.forename: T R
authors.initials: TR
authors.lastname: Gadacz
authors.forename: T A
authors.initials: TA
authors.lastname: Gordon
authors.forename: G F
authors.initials: GF
authors.lastname: Anderson
mesh_terms: D000368:Aged; D002763:Cholecystectomy / Q000191:economics*; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003657:Decision Making; D005249:Fees and Charges; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000191:economics*; D008875:Middle Aged; D011788:Quality of Life; D011859:Radiography; D015996:Survival Rate