Is it worth offering a routine laparoscopic cholecystectomy in developing countries? A Thailand case study

Area of Science:

• Health Economics
• Surgical Outcomes
• Public Health Policy

Background:

• Gallstone disease management presents a significant healthcare challenge globally.
• Laparoscopic cholecystectomy (LC) is increasingly adopted, but its cost-effectiveness varies by healthcare setting.
• Understanding the economic implications of LC versus open cholecystectomy (OC) in Thailand is crucial for resource allocation.

Purpose of the Study:

• To evaluate the cost-effectiveness of laparoscopic cholecystectomy (LC) compared to open cholecystectomy (OC) for gallstone disease in Thailand.
• To analyze costs from both societal and government perspectives.
• To inform healthcare policy regarding surgical management of gallstone disease.

Main Methods:

• A cost-utility analysis was performed from a societal perspective.
• Data on hospital and patient costs were collected from Chiang Rai regional hospital.
• Clinical outcomes were synthesized from a systematic review; a decision tree model calculated the incremental cost per Quality Adjusted Life Year (QALY).

Main Results:

• The incremental cost per QALY for LC over OC was 134,000 Baht (government) and 89,000 Baht (societal).
• LC's probability of being superior to OC exceeded 95% at ceiling ratios of 190,000 Baht (societal) and 270,000 Baht (government).
• These findings differ from developed countries where LC is often cost-saving.

Conclusions:

• Laparoscopic cholecystectomy (LC) is a cost-effective option for gallstone disease in Thailand, particularly at a threshold of three times per capita GDP.
• Differences in cost-effectiveness compared to developed countries are attributed to higher postoperative inpatient costs and lost working time values in Thailand.
• The study highlights the need for context-specific economic evaluations in healthcare.