Cholecystectomy: costs and health-related quality of life: a comparison of two techniques

Abstract

Total costs did not differ between minilaparotomy cholecystectomy and laparoscopic cholecystectomy with high-volume surgery and disposable trocars, whereas laparoscopic cholecystectomy was more expensive with fewer operations and disposable trocars. The gain in health-related quality of life with laparoscopic cholecystectomy compared with minilaparotomy cholecystectomy was small and of limited duration.

Clinical effectiveness and cost-effectiveness of cholecystectomy compared with observation/conservative management for preventing recurrent symptoms and complications in adults presenting with uncomplicated symptomatic gallstones or cholecystitis: a systematic review and economic evaluation

“…None of these studies compared conservative management with cholecystectomy. There were six papers that compared outcomes of different interventions such as mini laparotomy, lithotripsy, open cholecystectomy with laparoscopic cholecystectomy 116,117,[136][137][138][139] and one paper compared the different methods of valuing health-related QoL techniques, i.e. visual analogue scale and the standard gamble in measuring people preferences for outcomes of gallstone disease.…”

“…visual analogue scale and the standard gamble in measuring people preferences for outcomes of gallstone disease. 140 Two of the studies 117,139 that were conducted alongside RCTs used the European Quality of Life-5 Dimensions (EQ-5D). Although Nilsson and colleagues 139 collected data at five different time points (pre-operatively, post-operatively, 1 week, 1 month and 1 year), they did not report preference-based weights or estimate a QALY.…”

Quantification of the intensity of reactants acute phase response, pain perception and mood of open and laparoscopic cholecystectomy

“…Istraživanje švedskih autora Rosa i saradnika pokazalo je približnu strukturu životne dobi pacijenata otvorenom holecistektomijom. Slične rezultate prikazali su Leo i saradnici (distribucija životne dobi kretala se izmedju 46 i 68 godina) (12,18). Prosječna tjelesna težina pacijenata operisanih laparoskopskom holecistektomijom iznosila je 67,02 kg, a kod klasično operisanih 75,90 kg.…”

“…Dobijene prosječne vrijednosti kod mini laparotomisanih pacijenata bile su više u odnosu na prosječne vrijednosti kod klasično operisanih pacijenata I statistička analiza pokazala je postojanje značajne razlike. (9,12,23) Đaciniti i saradnici (24) takodje navode postojanje statistički značajne razlike u ispitivanom postoperativnom raspoloženju izmedju dvije grupe pacijenata i navode u dijelu zaključka da su se pacijenti iz grupe sa učinjenom laparoskopskom holecistektomijom brže oporavljali i sledstveno tome lakše vraćali svakodnevnim radnim aktivnostima u kasnijem periodu. Novicki i saradnici medjutim nisu utvrdili postojanje ove razlike koja je od značajnog uticaja za ukupan postoperativni oporavak (25).…”

Reply to Chen et al

“…Economic evaluations conducted in developed countries have so far favored laparoscopic cholecystectomy over open cholecystectomy, but the cost savings of laparoscopic cholecystectomy may be less apparent in other types of institutions 4 or when compared with minilaparotomy cholecystectomy. 5 Moreover, some ways in which laparoscopic cholecystectomy has demonstrated clear superiority over open cholecystectomy, such as shorter associated sick leave, do not necessarily represent a clear benefit to health plans and, accordingly, do not enter in their cost-effectiveness equations. More importantly, even with the assumption that laparoscopic cholecystectomy is cost effective, laparoscopic cholecystectomy savings may not overcome the increased consumption of healthcare resources resulting from the well-known rise in the number of cholecystectomies performed and in hospital use after laparoscopic cholecystectomy is introduced.…”