Laparoscopic cholecystectomy: a good buy? A cost comparison with small-incision (mini) cholecystectomy

Abstract

Objectives: To compare inpatient costs for laparoscopic and small-incision cholecystectomy.

Design: Retrospective analysis using results of a single blind prospective randomised trial.

Setting: Teaching hospital, UK.

Subjects: 200 patients having elective cholecystectomy.

Interventions: Standard laparoscopic cholecystectomy with conversion to open cholecystectomy if necessary. Small-incision cholecystectomy using high right transverse epigastric incision, enlarged if necessary for safe exposure.

Main outcome measures: Providers inpatient costs.

Results: Small-incision cholecystectomy cost Pound Sterling 995 and was 29% less expensive than the laparoscopic procedure which cost Pound Sterling 1397. Costs of equipment and operations themselves accounted for most of the difference. Results also suggest that costs to patients and society from time lost away from work may be lower for mini-cholecystectomy.

Conclusions: The national health service could be spending over Pound Sterling 10m a year by encouraging laparoscopic rather than small-incision operations for cholecystectomy. Commissioners of health care should question whether the benefits of laparoscopic surgery justify the additional costs.