Laparotomy Versus Laparoscopy Cholecystectomy for Surgical Treatment in Patients with Gallstone Disease: A Comparative Cost-Effectiveness Analysis

Nayeb Fadaei  Dehcheshmeh; Hamed  Abdollahi; Mohammadhosein  Haghighizadeh; Farzad  Faraji-Khiavi

doi:10.18502/htaa.v8i4.16986

Nayeb Fadaei Dehcheshmeh Department of Public Health, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
Hamed Abdollahi Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Mohammadhosein Haghighizadeh Department of Statistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Farzad Faraji-Khiavi Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

DOI: https://doi.org/10.18502/htaa.v8i4.16986

Keywords: Cholecystectomy; Laparoscopy; Laparotomy; Sensitivity Analysis; Cost-Effectiveness

Abstract

Background: Due to the increasing costs of the healthcare system and limited financial resources, healthcare policymakers should adopt more cost-effective strategies.

Objectives: This study aimed to compare the cost-effectiveness of laparotomy cholecystectomy with laparoscopy.

Methods: This economic evaluation was conducted on patients with cholecystitis who were candidates for surgery in a private hospital in Ahvaz in 2021. Data collection tools consisted of four parts: (1) demographic information checklist; (2) clinical information checklist; (3) cost checklist; and (4) effectiveness assessment tool. SPSS²² and STATA^14.2 were used for data analysis. One-way sensitivity analysis and Tornado diagrams were performed using Tree Age software.

Results: The mean total effectiveness score in patients treated with laparoscopy was 83.44 (SD = 11.34), which was higher than those treated with laparotomy at 68.39 (SD = 13.61). This difference was statistically significant in all effectiveness criteria, except for postoperative infection rates and length of operation (P < 0.001). The mean cost for patients undergoing laparoscopy was significantly higher than for those undergoing laparotomy ($481.43 vs. $459.49). However, overall, laparoscopic treatment (5.77) was more cost-effective than laparotomy (6.71). The laparoscopic procedure was approximately $1.47 per effectiveness unit cheaper than laparotomy, according to the ICER. One-way sensitivity analysis showed that the laparoscopic method remained more cost-effective, even when adjusting for cost and effectiveness components.

Conclusions: Although laparoscopic cholecystectomy was more expensive than laparotomy cholecystectomy, it was generally more cost- effective. The results of this research may assist Iran’s healthcare policymakers and managers in promoting laparoscopic cholecystectomy in hospitals.