Abstract
BackgroundAfter its introduction, laparoscopic cholecystectomy rapidly expanded around the world and was accepted the procedure of choice by consensus. However, analysis of evidence shows no difference regarding primary outcome measures between laparoscopic and small-incision cholecystectomy. In absence of clear clinical benefit it may be interesting to focus on the resource use associated with the available techniques, a secondary outcome measure. This study focuses on a difference in costs between laparoscopic and small-incision cholecystectomy from a societal perspective with emphasis on internal validity and generalisabilityMethodsA blinded randomized single-centre trial was conducted in a general teaching hospital in The Netherlands. Patients with reasonable to good health diagnosed with symptomatic cholecystolithiasis scheduled for cholecystectomy were included. Patients were randomized between laparoscopic and small-incision cholecystectomy. Total costs were analyzed from a societal perspective.ResultsOperative costs were higher in the laparoscopic group using reusable laparoscopic instruments (difference 203 euro; 95% confidence interval 147 to 259 euro). There were no significant differences in the other direct cost categories (outpatient clinic and admittance related costs), indirect costs, and total costs. More than 60% of costs in employed patients were caused by sick leave.ConclusionBased on differences in costs, small-incision cholecystectomy seems to be the preferred operative technique over the laparoscopic technique both from a hospital and societal cost perspective. Sick leave associated with convalescence after cholecystectomy in employed patients results in considerable costs to society.Trial registrationISRCTN Register, number ISRCTN67485658.
Highlights
After its introduction, laparoscopic cholecystectomy rapidly expanded around the world and was accepted the procedure of choice by consensus
In absence of clear clinical benefit based on these meta-analyses it may be interesting to focus on the resource use associated with the available techniques
In meta-analyses we found no major differences in clinical outcome measures between laparoscopic cholecystectomy (LC) and small-incision cholecystectomy (SIC) for patients with symptomatic cholecystolithiasis.[8]
Summary
Laparoscopic cholecystectomy rapidly expanded around the world and was accepted the procedure of choice by consensus. Analysis of evidence shows no difference regarding primary outcome measures between laparoscopic and small-incision cholecystectomy. In absence of clear clinical benefit it may be interesting to focus on the resource use associated with the available techniques, a secondary outcome measure. Laparoscopic cholecystectomy (LC) was introduced, and rapidly expanded around the world [4] The popularity of this procedure was partly based on an appealing technological innovation as well as industry driven motives and not primarily a result of an evidence-based approach [5]. Analysis of evidence in Cochrane reviews shows no difference regarding primary outcome measures (mortality and complications) between the three operative techniques of cholecystectomy (open, small-incision and laparoscopic) [6,7,8]. In a previous paper we emphasized intrinsic validity of this trial, proved reproducibility of results from other trials and showed generalisability in a general teaching hospital.[9]
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