Cost-effectiveness of extracorporeal shock-wave lithotripsy versus cholecystectomy for symptomatic gallstones.
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.
Bass
E B
EB
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Steinberg
E P
EP
Pitt
H A
HA
Saba
G P
GP
Lillemoe
K D
KD
Kafonek
D R
DR
Gadacz
T R
TR
Gordon
T A
TA
Anderson
G F
GF
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