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Gallstone lithotripsy vs cholecystectomy. A preliminary cost-benefit analysis
J G Rothschild1, R F Holbrook, R B Reinhold
1New England Medical Center, Boston, Mass.
Archives of Surgery (Chicago, Ill. : 1960)
|June 1, 1990
Summary
Extracorporeal shock wave lithotripsy (ESWL) for gallstones is initially less costly and offers faster recovery than cholecystectomy. While ESWL may require re-treatment, it significantly shortens the return to normal activity.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Medical Economics
Background:
- Symptomatic cholelithiasis (gallstones) necessitates effective treatment options.
- Traditional cholecystectomy involves significant recovery time and cost.
- Emerging technologies like extracorporeal shock wave lithotripsy (ESWL) offer alternatives.
Purpose of the Study:
- To compare elective cholecystectomy with ESWL for symptomatic cholelithiasis.
- To evaluate differences in treatment, hospitalization, recovery, and cost.
- To assess the initial efficacy and economic impact of ESWL.
Main Methods:
- Prospective comparison of 48 patients undergoing cholecystectomy versus 18 patients undergoing ESWL.
- Data collection on surgery/treatment length, hospital stay, total cost, morbidity, and return to work.
- Monitoring for side effects such as hematuria and petechiae.
Main Results:
- Cholecystectomy: 76 min surgery, 4-day stay, $6240 cost, 10% morbidity, 5-week return to work.
- ESWL: 136 min treatment, 2-day stay, $5921 cost, 33% hematuria, 28% petechiae, 3-day return to work.
- ESWL re-treatment cost estimated at $4880; recurrence/re-treatment rates pending FDA study.
Conclusions:
- ESWL is initially less costly than cholecystectomy for gallstone treatment.
- ESWL offers a dramatically shortened return to normal activity.
- Further cost reductions for ESWL are probable with outpatient procedures, despite potential re-treatment needs.