Is it worth offering a routine laparoscopic cholecystectomy in developing countries? A Thailand case study
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BioMed Central
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Is it worth offering a routine laparoscopic cholecystectomy in developing countries? A Thailand case study Yot Teerawattananon*1,2 and Miranda Mugford2 Address: 1International health Policy Program, Bureau of Policy and Strategy, Ministry of Public Health, Nonthaburi, Thailand and 2School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK Email: Yot Teerawattananon* - [email protected]; Miranda Mugford - [email protected] * Corresponding author
Published: 31 October 2005 Cost Effectiveness and Resource Allocation 2005, 3:10
doi:10.1186/1478-7547-3-10
Received: 21 August 2005 Accepted: 31 October 2005
This article is available from: http://www.resource-allocation.com/content/3/1/10 © 2005 Teerawattananon and Mugford; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Objective: The study aims to investigate whether laparoscopic cholecystectomy (LC) is a costeffective strategy for managing gallbladder-stone disease compared to the conventional open cholecystectomy(OC) in a Thai setting. Design and Setting: Using a societal perspective a cost-utility analysis was employed to measure programme cost and effectiveness of each management strategy. The costs borne by the hospital and patients were collected from Chiang Rai regional hospital while the clinical outcomes were summarised from a published systematic review of international and national literature. Incremental cost per Quality Adjusted Life Year (QALY) derived from a decision tree model. Results: The results reveal that at base-case scenario the incremental cost per QALY of moving from OC to LC is 134,000 Baht under government perspective and 89,000 Baht under a societal perspective. However, the probabilities that LC outweighed OC are not greater than 95% until the ceiling ratio reaches 190,000 and 270,000 Baht per QALY using societal and government perspective respectively. Conclusion: The economic evaluation results of management options for gallstone disease in Thailand differ from comparable previous studies conducted in developed countries which indicated that LC was a cost-saving strategy. Differences were due mainly to hospital costs of post operative inpatient care and value of lost working time. The LC option would be considered a costeffective option for Thailand at a threshold of three times per capita gross domestic product recommended by the committee on the Millennium Development Goals.
Introduction It is widely accepted that laparoscopic cholecystectomy (LC) is the first-line treatment for uncomplicated gallstone disease in developed countries where up to 80% of all cholecystectomy is performed through laparoscopy [13].
In contrast to the conventional open cholecystectomy (OC), which is performed through an appro
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