Cost-effectiveness analysis of laparoscopic versus minilaparotomy cholecystectomy for gallstone disease - A randomized trial

Objective: To evaluate the total cost of minilaparotomy cholecystectomy (MC ) and laparoscopic cholecystectomy (LC) and perform a cost-effectiveness (C E) analysis. Methods: One hundred adult subjects with painful gallstone disease were ran domized: 59 cases for LC and 41 cases for MC. Patients with gallstones show n on ultrasound with normal common bile duct and no history of icterus were included after an informed consent. Cases with acute cholecystitis and rai sed alkaline phosphatase were excluded. LC was performed using CO2 insuffla tion and a Storz 2D video camera. MC was done by transverse rectus cutting incision. Outcome was coded as success or failure. Success was defined as o peration without injury to bile duct, viscera or vessels, minimal pain and discomfort at 4 weeks, no wound infection up to 4 weeks, and resumption of work within 2 weeks of operation. The total cost of each case included cost of investigations, cost of disposable articles for operation, cost of drug s, cost of hospital stay, and cost of operation including anesthesia. LC an d MC were done with reusable instruments. A "societal viewpoint" has been t aken in the cost calculations. Results: There were 50/59 successful outcomes in LC and 15/40 outcomes in M C group. Total cost for LC was 386,769 rupees (Rs) and for MC was Rs 205,04 1. CE in LC was Rs 7,735 and in MC was Rs 13,669. Incremental CE ratio comp aring LC with MC was 3,028.33. Conclusion: LC is a more cost-effective method for treatment of gallstone d isease.