Cost-effectiveness of laparoscopic versus open cholecystectomy
Keywords:
Cholecystectomy, laparoscopic, cost-benefit analysis, health economics, Colombia
Abstract
Introduction. Cholecystectomy has been the subject of several clinical and cost comparison studies.
Objective. The results of open or laparoscopy cholecystectomy were compared in terms of cost and effectiveness from the perspective of healthcare institutions and from that of the patients.
Materials and methods. The cost-effectiveness study was undertaken at two university hospitals in Bogotá, Colombia. The approach was to select the type of cholecystectomy retrospectively and then
assess the result prospectively. The cost analysis used the combined approach of micro-costs and daily average cost. Patient resource consumption was gathered from the time of surgery room entry
to time of discharge. A sample of 376 patients with cholelithiasis/cystitis (May 2005-June 2006) was selected--156 underwent open cholecystectomy and 220 underwent laparoscopic cholecystectomy.
The following data were tabulated: (1) frequency of complications and mortality, post-surgical hospital stay, (2) reincorporation to daily activities, (3) surgery duration, (4) direct medical costs, (5) costs to the patient, and (6) mean and incremental cost-effectiveness ratios.
Results. Frequency of complications was 13.5% for open cholecystectomy and 6.4% for laparoscopic cholecystectomy (p=0.02); hospital stay was longer in open cholecystectomy than in laparoscopic cholecystectomy (p=0.003) as well as the reincorporation to daily activities reported by the patients (p<0.001). The duration of open cholecystectomy was 22 min longer than laparoscopic cholecystectomy (p<0.001). The average cost of laparoscopic cholecystectomy was lower than open cholecystectomy and laparoscopic cholecystectomywas more cost-effective than open cholecystectomy (US$ 995 vs. US$ 1,048, respectively). The patient out-of-pocket expenses were greater in open cholecystectomy compared to laparoscopic cholecystectomy (p=0.015). Mortality was zero.
Conclusions: The open laparoscopy procedure was associated with longer hospital stays, whereas the cholecystectomy procedure required a longer surgical duration. The direct cost of the latter was
lower for both for the healthcare institution and patients. The cost-effectiveness for both procedures was comparable.
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References
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15. Gaitán H, Eslava-Schmalbach J, Gómez P. Cost effectiveness of diagnostic laparoscopy in reproductive aged females suffering from non-specific acute low abdominal pain. Rev Salud Pública. 2005;7:166-79.
16. Kesteloot K, Penninckx F. The cost and effects of open versus laparoscopic cholecystectomies. Health Econ. 1993;2:303-12.
17. Ruangsin S, Jaroonrach V, Petpichetchian C, Puttawibul P, Sunpaweravong S, Chewatanagongun S. Establishment the cost-effectiveness through set criteria of laparoscopic cholecystectomy. J Med Assoc Thai. 2010;93:789-93.
18. Srivastava A, Srinivas G, Misra MC, Pandav CS, Seenu V, Goyal A. Cost-effectiveness analysis of laparoscopic versus minilaparotomy cholecystectomy for gallstone disease. A randomized trial. Int J Technol Assess Health Care. 2001l;17:497-502.
19. Olaya C, Carrasquilla G. Meta-análisis de efectividad de la colecistectomía laparoscópica frente a la abierta. Revista Colombiana de Cirugía. 2006;21:104-15.
20. Rosen MJ, Malm JA, Tarnoff M, Zuccala K, Ponsky JL. Cost-effectiveness of ambulatory laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2001;11:182-4.
21. Barkun JS, Caro JJ, Barkun AN, Trindade E. Costeffectiveness of laparoscopic and mini-cholecystectomy in a prospective randomized trial. Surg Endosc. 1995;9:1221-4.
22. McKellar DP, Johnson RM, Dutro JA, Mellinger J, Bernie WA, Peoples JB. Cost-effectiveness of laparoscopic cholecystectomy. Surg Endosc. 1995;9:158-62.
23. Mowschenson PM. Improving the cost-effectiveness of laparoscopic cholecystectomy. J Laparoendosc Surg. 1993;3:113-9.
24. Nicholl JP, Brazier JE, Milner PC, Westlake L, Kohler B, Williams BT, et al. Randomized controlled trial of costeffectiveness of lithotripsy and open cholecystectomy as treatments for gallbladder stones. Lancet. 1992;340:801-7.
25. Schirmer BD, Dix J. Cost effectiveness of laparoscopic cholecystectomy. J Laparoendosc Surg. 1992;2:145-50.
26. Pietrafitta JJ, Graner TJ, Nervick JM. Laparoscopic cholecystectomy: Cost effectiveness and quality enhancement. Int Surg. 1994;79:195-201.
27. Alinder G, Herlin P, Holmin T, Lindgren B. Routine operative cholangiography or pre-operative infusion cholangiography at elective cholecystectomy-a cost-effectiveness analysis. Acta Chir Scand. 1987;153:431-5.
28. Reder VA, Fineberg HV, Rosoff CB, White LS. Shorter length of stay for simple cholecystectomy: Cost-effectiveness of alternative strategies. Med Care. 1983;21:745-54.
29. Velu PP, Hor K, Leighton S, Yeoh SE, Duxbury M. Cost-utility and value-of-information analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2010;97:1149-50.
30. Wilson E, Gurusamy K, Gluud C, Davidson BR. Cost-utility and value-of-information analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2010;97:210-9.
31. Clements WD. Commentary on cost-utility and value-ofinformation analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2010;97:219.
32. Mercer S. Letter 2: prospective randomized trial using cost-utility analysis of early versus delayed laparoscopic cholecystectomy for acute gallbladder disease. Br J Surg. 2009;96:1492-3.
33. Cervantes J. Historia de la colecistectomía por laparoscopia. En: Cervantes J, Patiño JF, editores. Cirugía laparoscópica y toracoscópica. México: McGraw-Hill; 1997. p. 45-50.
2. Bass EB, Pitt HA, Lillemoe KD. Cost-effectiveness of laparoscopic cholecystectomy versus open cholecystectomy. Am J Surg. 1993;165:466-71.
3. Bosch F, Wehrman U, Saeger H, Kirch W. Laparoscopic or open conventional cholecystectomy: Clinical and economic considerations. Eur J Surg. 2002;168:270-7.
4. De Pouvourville G, Ribet-Reinhart N, Fendrick M, Houry S, Testas P, Huguier M. A prospective comparison of costs and morbidity of laparoscopic versus open cholecystectomy. Hepatogastroenterology. 1997;44:35-9.
5. Zacks S, Sandler R, Rutledge R, Brown R. A populationbased cohort study comparing laparoscopic cholecystectomy and open cholecystectomy. Am J Gastroenterol. 2002;97:334-40.
6. Charlo T, Fernández M, Tejido C. Análisis de costes de la colecistectomía laparoscópica en comparación con la abierta. Rev Esp Enf Digest. 1995;87:449-52.
7. Moore JH, Rodríguez S, Roa A, Girón M, Sanabria A, Rodríguez P, et al. Colecistectomía laparoscópica ambulatoria: modelo de programa costo-eficiente de cirugía laparoscópica. Revista Colombiana de Cirugía. 2004;19:43-53.
8. Olaya C, Carrasquilla G. Modelo de costo efectividad de la colecistectomía laparoscópica versus abierta. Bogotá: Fundación Santa Fe de Bogotá; 2004.
9. Hannan E, Imperato PJ, Nenner R, Harriet S. Laparoscopic an open cholecystectomy in New York State: Mortality, complications, and choice of procedure. Surgery. 1999;125:223-31.
10. Wolters T, Wolf H, Schroder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77:217-22.
11. Drumond MF, O'Brien BJ, Stoddart GL, Torrance GW. Métodos para la evaluación económica de los programas de asistencia sanitaria. Segunda edición. Madrid: Ediciones Días de Santos S.A.; 2001.
12. Gold MR, Siegel JE, Russell LB, Weinstein MC. Costeffectiveness in health and medicine. New York: Oxford University Press; 1996. p. 176-220.
13. Petitti DB. Meta-analysis, decision analysis and costeffectiveness analysis. Methods for quantitative synthesis in medicine. Second edition. New York: Oxford University Press; 2000. p. 17.
14. Karnon J, Brown J. Selecting a decision model for economic evaluation: A case study and review. Health Care Manag Sci. 1998;1:133-40.
15. Gaitán H, Eslava-Schmalbach J, Gómez P. Cost effectiveness of diagnostic laparoscopy in reproductive aged females suffering from non-specific acute low abdominal pain. Rev Salud Pública. 2005;7:166-79.
16. Kesteloot K, Penninckx F. The cost and effects of open versus laparoscopic cholecystectomies. Health Econ. 1993;2:303-12.
17. Ruangsin S, Jaroonrach V, Petpichetchian C, Puttawibul P, Sunpaweravong S, Chewatanagongun S. Establishment the cost-effectiveness through set criteria of laparoscopic cholecystectomy. J Med Assoc Thai. 2010;93:789-93.
18. Srivastava A, Srinivas G, Misra MC, Pandav CS, Seenu V, Goyal A. Cost-effectiveness analysis of laparoscopic versus minilaparotomy cholecystectomy for gallstone disease. A randomized trial. Int J Technol Assess Health Care. 2001l;17:497-502.
19. Olaya C, Carrasquilla G. Meta-análisis de efectividad de la colecistectomía laparoscópica frente a la abierta. Revista Colombiana de Cirugía. 2006;21:104-15.
20. Rosen MJ, Malm JA, Tarnoff M, Zuccala K, Ponsky JL. Cost-effectiveness of ambulatory laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2001;11:182-4.
21. Barkun JS, Caro JJ, Barkun AN, Trindade E. Costeffectiveness of laparoscopic and mini-cholecystectomy in a prospective randomized trial. Surg Endosc. 1995;9:1221-4.
22. McKellar DP, Johnson RM, Dutro JA, Mellinger J, Bernie WA, Peoples JB. Cost-effectiveness of laparoscopic cholecystectomy. Surg Endosc. 1995;9:158-62.
23. Mowschenson PM. Improving the cost-effectiveness of laparoscopic cholecystectomy. J Laparoendosc Surg. 1993;3:113-9.
24. Nicholl JP, Brazier JE, Milner PC, Westlake L, Kohler B, Williams BT, et al. Randomized controlled trial of costeffectiveness of lithotripsy and open cholecystectomy as treatments for gallbladder stones. Lancet. 1992;340:801-7.
25. Schirmer BD, Dix J. Cost effectiveness of laparoscopic cholecystectomy. J Laparoendosc Surg. 1992;2:145-50.
26. Pietrafitta JJ, Graner TJ, Nervick JM. Laparoscopic cholecystectomy: Cost effectiveness and quality enhancement. Int Surg. 1994;79:195-201.
27. Alinder G, Herlin P, Holmin T, Lindgren B. Routine operative cholangiography or pre-operative infusion cholangiography at elective cholecystectomy-a cost-effectiveness analysis. Acta Chir Scand. 1987;153:431-5.
28. Reder VA, Fineberg HV, Rosoff CB, White LS. Shorter length of stay for simple cholecystectomy: Cost-effectiveness of alternative strategies. Med Care. 1983;21:745-54.
29. Velu PP, Hor K, Leighton S, Yeoh SE, Duxbury M. Cost-utility and value-of-information analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2010;97:1149-50.
30. Wilson E, Gurusamy K, Gluud C, Davidson BR. Cost-utility and value-of-information analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2010;97:210-9.
31. Clements WD. Commentary on cost-utility and value-ofinformation analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2010;97:219.
32. Mercer S. Letter 2: prospective randomized trial using cost-utility analysis of early versus delayed laparoscopic cholecystectomy for acute gallbladder disease. Br J Surg. 2009;96:1492-3.
33. Cervantes J. Historia de la colecistectomía por laparoscopia. En: Cervantes J, Patiño JF, editores. Cirugía laparoscópica y toracoscópica. México: McGraw-Hill; 1997. p. 45-50.
How to Cite
1.
Fajardo R, Valenzuela JI, Olaya SC, Quintero G, Carrasquilla G, Pinzón CE, et al. Cost-effectiveness of laparoscopic versus open cholecystectomy. Biomed. [Internet]. 2011 Jun. 30 [cited 2025 Apr. 5];31(4):514-24. Available from: https://revistabiomedicaorg.biteca.online/index.php/biomedica/article/view/405
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