Economics of surgery

The time has come to subject surgery to the same rigours of economic assess ment that other health-care sectors are already receiving-namely, the compa rative assessment of costs and benefits. The surgical management of gallsto nes provides a good example of the role of economics in surgery. Gallstone disease is common and patients are usually referred to a surgeon, but the t hreshold for intervention is not agreed and varies widely, with considerabl e implications for resources. Gallstone removal has been subject to much in novation over the past 1.0 years, yet economic assessment of laparoscopic a nd "mini" cholecystectomy and of gallstone lithotripsy Is rare, despite the fact that operation rates have Increased by up to 50% In some countries. F or surgery to compete with other interventions, economic assessment of new surgical techniques will be increasingly important. This assessment should be based on well-conducted clinical trials In which interventions are provi ded in a routine service setting, and in which benefits are assessed among other things on the basis of the patient's perceived quality of life. Econo mic assessment often needs data beyond those collected In a clinical trial, however pragmatic the trial design, so modelling will often be required, i ncorporating a range of sources of evidence. Finally, evidence alone will n ot be enough to promote cost-effective practices. The take-up of surgical t echniques will always be affected by the way hospitals and surgeons are rem unerated. Affecting practice requires a realistic system of reimbursement t hat reflects evidence on cost effectiveness.