title: Laparoscopic Versus Open Cholecystectomy: A Cost-Effectiveness Analysis at Rwanda Military Hospital.
abstract: Laparoscopic cholecystectomy is first-line treatment for uncomplicated gallstone disease in high-income countries due to benefits such as shorter hospital stays, reduced morbidity, more rapid return to work, and lower mortality as well-being considered cost-effective. However, there persists a lack of uptake in low- and middle-income countries. Thus, there is a need to evaluate laparoscopic cholecystectomy in comparison with an open approach in these settings.
  
  
  
  A cost-effectiveness analysis was performed to evaluate laparoscopic and open cholecystectomies at Rwanda Military Hospital (RMH), a tertiary care referral hospital in Rwanda. Sensitivity and threshold analyses were performed to determine the robustness of the results.
  
  
  
  The laparoscopic and open cholecystectomy costs and effectiveness values were $2664.47 with 0.87 quality-adjusted life years (QALYs) and $2058.72 with 0.75 QALYs, respectively. The incremental cost-effectiveness ratio for laparoscopic over open cholecystectomy was $4946.18. Results are sensitive to the initial laparoscopic equipment investment and number of cases performed annually but robust to other parameters. The laparoscopic intervention is more cost-effective with investment costs less than $91,979, greater than 65 cases annually, or at willingness-to-pay (WTP) thresholds greater than $3975/QALY.
  
  
  
  At RMH, while laparoscopic cholecystectomy may be a more effective approach, it is also more expensive given the low caseload and high investment costs. At commonly accepted WTP thresholds, it is not cost-effective. However, as investment costs decrease and/or case volume increases, the laparoscopic approach may become favorable. Countries and hospitals should aspire to develop innovative, low-cost options in high volume to combat these barriers and provide laparoscopic surgery.
authors.affiliation: Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave #411, Boston, MA, 02115, USA.|University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Silverstein
authors.affiliation: Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave #411, Boston, MA, 02115, USA.|Rwanda Military Hospital, Kigali, Rwanda.
authors.forename: Ainhoa
authors.initials: A
authors.lastname: Costas-Chavarri
authors.affiliation: Rwanda Military Hospital, Kigali, Rwanda.
authors.forename: Mussa R
authors.initials: MR
authors.lastname: Gakwaya
authors.affiliation: Rwanda Military Hospital, Kigali, Rwanda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lule
authors.affiliation: Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave #411, Boston, MA, 02115, USA.|Department of Surgery, University of Connecticut, Farmington, CT, USA.
authors.forename: Swagoto
authors.initials: S
authors.lastname: Mukhopadhyay
authors.affiliation: Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave #411, Boston, MA, 02115, USA.|Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Meara
authors.affiliation: Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave #411, Boston, MA, 02115, USA. shrime@mail.harvard.edu.|Department of Otolaryngology and Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA. shrime@mail.harvard.edu.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Shrime
mesh_terms: D002763:Cholecystectomy / Q000191:economics* / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D042882:Gallstones / Q000601:surgery; D006772:Hospitals, Military; D006801:Humans; D020706:Laparoscopes / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012432:Rwanda