Cost-Utility Analysis Of Laparoscopic Cholecystectomy And Open Cholecystectomy In Kashani Hospital, Shahr-E-Kord, Iran

Background: A cost-effectiveness analysis is used to evaluate and compare the cost versus the benefits of different treatment modalities. The clinical effectiveness of laparoscopic cholecystectomy has been well documented. To our knowledge, there was no published data on the cost-utility of laparoscopic cholecystectomy in Iran.Objectives: This study aimed to compare the cost-utility of the two surgical methods for removing gallstones: open cholecystectomy and laparoscopic cholecystectomy.Patients and Methods: In this comparative cross-sectional analysis, we investigated the data of patients who had undergone laparoscopic and open cholecystectomy operations in Kashani hospital, Iran, between 2012 and 2014. Using the available samples, two groups of 30 patients were randomly selected. SF-36 was used to assess the quality of life (QoL) of patients 30 to 35 days after operation, and quality-adjusted life years (QALYs) were calculated by multiplying the SF-36 score by healthy years of life. An activity-based costing method was used to determine the costs of the operations. The cost-effectiveness ratio (CER) was calculated by dividing the costs of each method by the gained QALY. To determine the difference between the two surgical methods, we used independent-samples t test.Results: The data of 60 patients, 40 men and 20 women, with the mean age of 54.30 +/- 16.44 in the laparoscopic group and 51.77 +/- 18.41 in the open cholecystectomy group were analyzed. The mean cost of surgery was lower in the laparoscopy group (2259 +/- 895 USD) than in the laparotomy group (2972 +/- 907.9 USD) (P = 0.003). The mean SF-36 score was higher in the laparoscopic group (65.98 +/- 9.22) than in the open cholecystectomy group (58.03 +/- 11.30) (P < 0.004). The cost of gaining QALY was also significantly lower in the laparoscopic group. The mean of the gained QALY index was 1.79 +/- 0.29 and 1.14 +/- 0.41 for the laparoscopic and open surgeries, respectively (P < 0.001). The incremental CER was 1067 USD for each QALY for the laparoscopic group in comparison to the value of open cholecystectomy.Conclusions: Laparoscopic cholecystectomy was more cost-effective than open cholecystectomy and is therefore preferred and recommended in patients with gallstones.