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Costs and Effectiveness of Extracorporeal Gallbladder Stone Shock Wave Lithotripsy Versus Laparoscopic Cholecystectomy: A Randomized Clinical Trial

Published online by Cambridge University Press:  10 March 2009

Alan N. Barkun ,
Jeffrey S. Barkun ,
John S. Sampalis ,
Jaime Caro ,
Gerald M. Fried ,
Johnathan L. Meakins ,
Lawrence Joseph  and
Carl A. Goresky
Alan N. Barkun
Affiliation:
The Montreal General Hospital
Jeffrey S. Barkun
Affiliation:
The Royal Victoria Hospital
John S. Sampalis
Affiliation:
The Montreal General Hospital
Jaime Caro
Affiliation:
The Royal Victoria Hospital
Gerald M. Fried
Affiliation:
The Montreal General Hospital
Johnathan L. Meakins
Affiliation:
The Royal Victoria Hospital
Lawrence Joseph
Affiliation:
The Montreal General Hospital
Carl A. Goresky
Affiliation:
The Montreal General Hospital
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Abstract

Thirty-five patients were randomized to extracorporeal shock-wave lithotripsy (ESWL) and 25 to laparoscopic cholecystectomy (LC). Stone disappearance occurred in only 12 of 32 ESWL patients [38% (95% Cl: 21–56%)] during a 15-month follow-up. Greater incremental gains in quality of life after 6 months were observed among LC patients (p <.01). Total duration of disability was 6.8 ± 8.5 days for ESWL, and 22.7 ± 16.6 days for LC (p <.01). Nine (28%) patients crossed over electively to the LC group, but only 44% of these underwent LC within the next 3 years. ESWL cost Can $58.9/ day of disability saved. ESWL is limited by its selective applicability and modest stone disappearance rate. Its cost-effectiveness is largely dependent on patient acceptance of recurrent episodes of biliary colic due to the persistence of stone fragments.

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 13 , Issue 4 , Fall 1997 , pp. 589 - 601
Copyright
Copyright © Cambridge University Press 1997

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