SYMPTOMATIC GALLBLADDER STONES - COST-EFFECTIVENESS OF TREATMENT WITHEXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY, CONVENTIONAL AND LAPAROSCOPIC CHOLECYSTECTOMY

In order to strike the most favorable balance between health benefits and costs, three treatment modalities for symptomatic cholelithiasis w ere compared in a cost-effectiveness study: extracorporeal shock-wave lithotripsy (ESWL), conventional cholecystectomy (CC), and laparoscopi c cholecystectomy (LC). Data were analyzed from 55 patients who were t reated by ESWL, 45 patients who had CC, and 47 patients who had LC. Th e study was performed by analysis of patients charts and a written que stionnaire. After ESWL 35% of the patients were free of stones, 23% ha d fragments less-than-or-equal-to 5 mm, and 42% had fragments >5 mm at 1-year follow-up. Persistent complaints were reported by 59% after ES WL, 11% after CC, and 14% after LC (P < 0.001). New complaints arose i n 12% after ESWL, 11% after CC, and in 5% after LC (P = NS). Patient a ppreciation score was highest for LC and lowest for ESWL. Mean hospita l stay was 2.4 days for ESWL, 10 days for CC, and 3.5 days for LC. Ove rall costs of treatment were: $5,066 for ESWL; $5,893 for CC; and $3,1 17 for LC. This study reveals that laparoscopic cholecystectomy is the most effective treatment of the large majority of patients with sympt omatic cholelithiasis. ESWL should only be considered in the case of a solitary, relatively small, completely radiolucent stone.