Document Type : Research articles
Authors
1 Department of Health Economics, School of Health Management and Information Science, Iran University of Medical Sciences, Tehran, IR Iran
2 Department of Statistic and Mathematics, School of Health, Tehran University of Medical Sciences, Tehran, IR Iran
3 School of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran
Abstract
Background: A cost-effectiveness analysis is used to evaluate and compare the cost versus the benefits of different treatment modal- ities. The clinical effectiveness of laparoscopic cholecystectomy has been well documented. To our knowledge, there was no pub- lished 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 cholecystec-
tomy and laparoscopic cholecystectomy. Patients and Methods: In this comparative cross-sectional analysis, we investigated the data of patients who had undergone la- paroscopic 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 af- ter 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.
Keywords
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