Laparotomy versus laparoscopy cholecystectomy for surgical treatment in patients with gallstone disease: a comparative cost-effectiveness analysis
Laparotomy versus laparoscopy cholecystectomy cost-effectiveness analysis
Abstract
Background: Due to the increasing costs of the health system and limited financial resources, healthcare policymakers should apply more cost-effective strategies. This study aimed to compare the cost-effectiveness of laparotomy cholecystectomy with laparoscopy.
Methods: This economic evaluation was performed on patients with cholecystitis who were candidate for surgery in a private hospital in Ahvaz, in 2021. Data collection tools consisted of 4 parts: 1) demographic information checklist; 2) clinical information checklist; 3) cost checklist and 4) effectiveness assessment tool. We used SPSS22 and STATA14.2 for data analysis. One-way sensitivity analysis and Tornado diagrams were performed using Tree Age software.
Results: The mean total effectiveness score in patients treated with laparoscopy 83.44 (SD = 11.34) was higher than those treated with laparotomy 68.39 (SD = 13.61). This difference was statistically significant in all effectiveness criteria except for postoperative infection dimensions and length of operation (P-value <0.001). The mean cost in patients undergoing laparoscopy was significantly higher than those undergoing laparotomy (481.43 $ VS 459.49 $), but overall laparoscopic treatment (5.77) was more cost-effective than laparotomy (6.71). The cost-effectiveness of the laparoscopic procedure was approximately 1.47 $ per effectiveness unit cheaper than laparotomy, according to the ICER. According to one-way sensitivity analysis, the laparotomy method was still more effective by changing the cost and effectiveness components.
Conclusion: Although laparoscopic cholecystectomy was more expensive than laparotomy cholecystectomy, it was generally more cost-effective. The results of this research may help Iran’s health system policymakers and managers in order to extend laparoscopic cholecystectomy in hospitals.
2. Alishi YA, Howaish FA, Alhamdan FA, Almalki AA, Alqahtani SA, Alharthi SA, et al. Prevalence and risk factors for gallstones among population in Riyadh City, KSA 2017. The Egyptian Journal of Hospital Medicine. 2017;69(5):2384-8.
3. Organization WH. Gallbladder. Available from: https://gcoiarcfr/today/data/factsheets/cancers/12-Gallbladder-fact-sheetpdf. 2020.
4. Agabiti N, Stafoggia M, Davoli M, Fusco D, Barone AP, Perucci CA. Thirty-day complications after laparoscopic or open cholecystectomy: a population-based cohort study in Italy. BMJ open. 2013;3(2).
5. Phillips MS, Marks JM, Roberts K, Tacchino R, Onders R, DeNoto G, et al. Intermediate results of a prospective randomized controlled trial of traditional four-port laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy. Surgical endoscopy. 2012;26(5):1296-303.
6. Sajid MS, Ladwa N, Kalra L, Hutson KK, Singh KK, Sayegh M. Single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: meta-analysis and systematic review of randomized controlled trials. World journal of surgery. 2012;36(11):2644-53.
7. Shea JA, Healey MJ, Berlin JA, Clarke JR, Malet PF, Staroscik RN, et al. Mortality and complications associated with laparoscopic cholecystectomy. A meta-analysis. Annals of surgery. 1996;224(5):609.
8. Kane RL, Lurie N, Borbas C, Morris N, Flood S, McLaughlin B, et al. The outcomes of elective laparoscopic and open cholecystectomies. Journal of the American College of Surgeons. 1995;180(2):136-45.
9. Gutt CN, Encke J, Köninger J, Harnoss J-C, Weigand K, Kipfmüller K, et al. Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304). Annals of surgery. 2013;258(3):385-93.
10. Gurusamy KS, Davidson C, Gluud C, Davidson BR. Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. Cochrane Database of Systematic Reviews. 2013(6).
11. Kortram K, van Ramshorst B, Bollen TL, Besselink MG, Gouma DJ, Karsten T, et al. Acute cholecystitis in high risk surgical patients: percutaneous cholecystostomy versus laparoscopic cholecystectomy (CHOCOLATE trial): study protocol for a randomized controlled trial. Trials. 2012;13(1):1-7.
12. Aboulian A, Chan T, Yaghoubian A, Kaji AH, Putnam B, Neville A, et al. Early cholecystectomy safely decreases hospital stay in patients with mild gallstone pancreatitis: a randomized prospective study. Annals of surgery. 2010;251(4):615-9.
13. Townsend C. Textbook of surgery 19th edition/Townsend CM Jr., Beauchamp RD, Evers BM, et al. Elsevier Health Sciences; 2012.
14. Andersen DK, Brunicardi FC. Schwartz's principles of surgery: McGraw-Hill, Medical Pub. Division; 2010.
15. Reza poor A EaF, Bagheri fardanbeh S, yousefzadeh N. Economic Evaluation (Understanding public health). Available from: https://wwwadinehbookcom/gp/product/9648147507. 2005:333-4.
16. Drummond MF, Mason AR. European perspective on the costs and cost-effectiveness of cancer therapies. Journal of Clinical Oncology. 2007;25(2):191-5.
17. Markar S, Karthikesalingam A, Thrumurthy S, Muirhead L, Kinross J, Paraskeva P. Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis. Surgical endoscopy. 2012;26(5):1205-13.
18. Lammert F, Sauerbruch T. Mechanisms of disease: the genetic epidemiology of gallbladder stones. Nature clinical practice Gastroenterology & hepatology. 2005;2(9):423-33.
19. Bank TW. Purchasing Power Parities (current international $). https://dataworldbankorg/indicator/PANUSPPP Accessed 25 July 2022. 2021.
20. Haddad S, Ghadimi K, Abrishamkar R, Asl NSM. Comparing laparoscopy and laparotomy procedures in the radical hysterectomy surgery for endometrial cancer: a basic review. American Journal of Translational Research. 2021;13(4):2456.
21. Capozzi VA, Sozzi G, Gambino G, Cianciolo A, Riccò M, Monfardini L, et al. Laparoscopy versus laparotomy for surgical treatment of obese women with endometrial cancer: A cost‑benefit comparative analysis. Molecular and Clinical Oncology. 2019;11(4):335-42.
22. Knaus ME, Onwuka AJ, Afrazi A, Breech L, Corkum KS, Dillon PA, et al. Laparoscopy versus laparotomy for pediatric ovarian dermoids. Journal of pediatric surgery. 2022;57(6):1008-12.
23. Hoyuela C, Juvany M, Guillaumes S, Ardid J, Trias M, Bachero I, et al. Long-term incisional hernia rate after single-incision laparoscopic cholecystectomy is significantly higher than that after standard three-port laparoscopy: a cohort study. Hernia. 2019;23(6):1205-13.
24. Cui N, Liu J, Tan H. Comparison of laparoscopic surgery versus traditional laparotomy for the treatment of emergency patients. Journal of International Medical Research. 2020;48(3):0300060519889191.
25. Silverstein A, Costas-Chavarri A, Gakwaya MR, Lule J, Mukhopadhyay S, Meara JG, et al. Laparoscopic versus open cholecystectomy: a cost–effectiveness analysis at Rwanda Military Hospital. World journal of surgery. 2017;41(5):1225-33.
26. Riviere D, Gurusamy KS, Kooby DA, Vollmer CM, Besselink MG, Davidson BR, et al. Laparoscopic versus open distal pancreatectomy for pancreatic cancer. Cochrane Database of Systematic Reviews. 2016(4).
27. Ge B, Wu M, Chen Q, Chen Q, Lin R, Liu L, et al. A prospective randomized controlled trial of laparoscopic repair versus open repair for perforated peptic ulcers. Surgery. 2016;159(2):451-8.
28. Schietroma M, Piccione F, Carlei F, Sista F, Cecilia EM, Amicucci G. RETRACTED: Peritonitis from Perforated Peptic Ulcer and Immune Response. Journal of Investigative Surgery. 2013;26(5):294-304.
29. Lai I-R, Chen C-N, Lin M-T, Lee P-H. Surgical treatment of gastric gastrointestinal stromal tumors: analysis of 92 operated patients. Digestive surgery. 2008;25(3):208-12.
Files | ||
Issue | Vol 8 No 4 (2024) | |
Section | Articles | |
Keywords | ||
Cholecystectomy, Laparoscopy, Laparotomy, Sensitivity analysis, Cost-effectiveness |
Rights and permissions | |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |