Costs and effectiveness of extracorporeal gallbladder stone shock wave lithotripsy versus laparoscopic cholecystectomy. A randomized clinical trial. McGill Gallstone Treatment Group.
Thirty-five patients were randomized to extracorporeal shock-wave lithotripsy (ESWL) and 25 to laparoscopic cholecystectomy (LC). Stone disappearance occurred in only 12 of 32 ESWL patients [38% (95% CI: 21-56%)] during a 15-month follow-up. Greater incremental gains in quality of life after 6 months were observed among LC patients (p < .01). Total duration of disability was 6.8 +/- 8.5 days for ESWL, and 22.7 +/- 16.6 days for LC (p < .01). Nine (28%) patients crossed over electively to the LC group, but only 44% of these underwent LC within the next 3 years. ESWL cost Can $58.9/ day of disability saved. ESWL is limited by its selective applicability and modest stone disappearance rate. Its cost-effectiveness is largely dependent on patient acceptance of recurrent episodes of biliary colic due to the persistence of stone fragments.
Barkun
A N
AN
Montreal General Hospital.
Barkun
J S
JS
Sampalis
J S
JS
Caro
J
J
Fried
G M
GM
Meakins
J L
JL
Joseph
L
L
Goresky
C A
CA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000191:economics / Q000534:rehabilitation; D002769:Cholelithiasis / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015993:Life Tables; D008096:Lithotripsy / Q000191:economics; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011792:Quebec; D018709:Statistics, Nonparametric; D013673:Technology Assessment, Biomedical / Q000191:economics*; D016896:Treatment Outcome