A Cost-Utility Study of Laparoscopic Cholecystectomy for the Treatment of Symptomatic Gallstones.

backgroundLaparoscopic cholecystectomy is a high-volume surgery that is an end-stage treatment for gallstones. There is little understanding of the surgery's effect on the gain in patients' health relative to its cost. The objective of this study is to measure health gain, cost and cost utility of elective laparoscopic cholecystectomy.

methodsParticipants completed the EQ-5D(3L) pre-operatively and post-operatively. Quality adjusted life years attributable to cholecystectomy were calculated by comparing health state utility values between the pre- and post-operative time points. Laparoscopic cholecystectomy cost was calculated from a health system perspective and included hospital and specialists' fees (in 2016 Canadian dollars). Cost per QALY was calculated for the entire sample and demographic sub-groups.

resultsThe cohort consisted of 135 participants who completed surveys between February 2013 and June 2017. The response rate among eligible patients was 50%. Assuming that health gain accrued to the participant for 25 years after cholecystectomy, the mean gain in QALYs was 1.7430, corresponding to an average cost per QALY of $2102. Older patients, on average, had less gain in QALYs than younger patients.

conclusionLaparoscopic cholecystectomies are inexpensive relative to the gains in health they provide patients. The gains in health were not uniform across age categories. These results should provide health system planners confidence that incremental increases in surgical capacity for elective cholecystectomies is beneficial.