Gallstone Disease: The Cost Of Treatment

This paper presents the methodology and results from the costing analysis of gallstone disease treatments. This was part of a larger cost utility analysis undertaken by the National Centre for Health Program Evaluation. Preliminary results from this are available in Cook, Richardson and Street (1993a). Issues relating to the assessment of the outcomes of treatment are discussed in Cook and Richardson (1993a and 1993b). The final report, which provides an overview of the economic evaluation, is forthcoming (Cook, Richardson and Street 1993b). The present paper discusses the estimation of hospital, patient and indirect costs associated with the three treatment options, open cholecystectomy, laparoscopic cholecystectomy, and extra-corporeal shockwave lithotripsy (ESWL). Results are based on a clinical trial conducted over a three year period at St Vincent's Hospital, Melbourne beginning in 1989. The methodology and various issues arising in the estimation of costs are described in detail. It was found that when only hospital costs were considered laparoscopic cholecystectomy was unambiguously the least expensive treatment. The inclusion of indirect and patient costs reduced the relative cost advantage of laparoscopic cholecystectomy over ESWL but did not negate it. Open cholecystectomy had lower hospital costs than ESWL but the inclusion of costs incurred outside the hospital resulted in ESWL being less expensive than open cholecystectomy. The cost of ESWL varied by stone size and number, the treatment for those with large stones (>20 mm diameter) costing approximately 50% more than for those with small stones (<10 mm diameter).