Cost Utility Analysis Of Treatment For Gallstone Disease: Interim Results

The paper considers three options for the treatment of gallstone disease vis, open cholecystectomy, extracorporeal shockwave lithotripsy and laparoscopic cholecystectomy. The analysis includes the direct hospital, treatment and patient costs of these procedures and the indirect, societal cost of foregone production. The reduced quality of life (QoL) associated with each treatment is measured using the techniques of cost utility analysis. Data were obtained from three sets of surveys: a series of open ended interviews of patients' QoL; a patient questionnaire and a series of population interviews to convert QoL scenarios into utility values using the time trade off and rating scale techniques. Results imply that, with certain caveats, laparoscopic cholecystectomy is unambiguously superior to the other two techniques with respect to both cost and outcome. Lithotripsy is cheaper than open cholecystectomy but because of its side effects may result in a lower post treatment QoL. Choice of open cholecystectomy may therefore increase healthy year equivalents (HYE-s) but at a treatment cost of $443,000 per HYE. The result is reversed if ursodeoxycholic acid is used as the adjacent bile salt regime. Unlike chenodeoxycholic acid, the use of ursodeoxycholic acid does not result in diarrhoea or nausea. At the time of the trial ursodeoxycholic acid was not available in Australia. The consequence of this is a significant reduction in the loss of HYE-s associated with lithotripsy. With the use of ursodeoxycholic acid, laparoscopic cholecystectomy would remain the cheaper procedure but lithotripsy would result in less loss of HYE-s. Lithotripsy would unambiguously be the cheapest option if it was available via the spare capacity of multi purpose lithotripters that were independently justified. Methodological issues discussed in the paper include the measurement of temporary health states, the ex ante and ex post perspectives in cost utility analysis and utility measurement with imperfect patient data.