Cost Utility Analysis of Treatment Options for Gallstone Disease: Final Report

An economic evaluation was conducted of treatment options for patients with symptomatic gallstone disease, namely open cholecystectomy, laparoscopic cholecystectomy and extra corporeal shockwave lithotripsy (ESWL). Because of the importance of quality of life following treatment, a cost utility analysis was selected as the appropriate method for the evaluation. Information was obtained from a clinical trial at St Vincent's Hospital in Melbourne. Further information on the outcomes of treatment were sought from clinical staff, the literature, and patients themselves. The utility associated with being in each post-treatment health state was assessed by presenting descriptions of these health states to members of the general public and asking them to evaluate each using the time trade-off technique. Data on resource use was derived from patient protocols devised by hospital staff and from a patient questionnaire. The cost analysis included hospital costs, costs borne by patients and care-givers, and the indirect costs of lost time to productive activity. The three treatments were compared in terms of their costs and outcomes, and the results subjected to sensitivity analysis. It was found that laparoscopic cholecystectomy was unambiguously superior to open cholecystectomy, and would generally be preferred to ESWL. In the absence of laparoscopic cholecystectomy, ESWL is unambiguously the preferred option if (1) indirect costs are included in the analysis or (2) when patients presenting with a small single stone. The present paper provides an overview of the study, its methods and it reports, in full, the results of the sensitivity analysis conducted. More detailed discussion of particular aspects of the study are presented in Cook and Richardson (1993a,b), Street (1993) and Cook, Richardson and Street (1994)