Allison Silverstein1,2, Ainhoa Costas-Chavarri1,3, Mussa R Gakwaya3, Joseph Lule3, Swagoto Mukhopadhyay1,4, John G Meara1,5, Mark G Shrime6,7. 1. Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave #411, Boston, MA, 02115, USA. 2. University of Miami Miller School of Medicine, Miami, FL, USA. 3. Rwanda Military Hospital, Kigali, Rwanda. 4. Department of Surgery, University of Connecticut, Farmington, CT, USA. 5. Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA. 6. Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave #411, Boston, MA, 02115, USA. shrime@mail.harvard.edu. 7. Department of Otolaryngology and Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA. shrime@mail.harvard.edu.
Abstract
BACKGROUND: Laparoscopic cholecystectomy is first-line treatment for uncomplicated gallstone disease in high-income countries due to benefits such as shorter hospital stays, reduced morbidity, more rapid return to work, and lower mortality as well-being considered cost-effective. However, there persists a lack of uptake in low- and middle-income countries. Thus, there is a need to evaluate laparoscopic cholecystectomy in comparison with an open approach in these settings. METHODS: A cost-effectiveness analysis was performed to evaluate laparoscopic and open cholecystectomies at Rwanda Military Hospital (RMH), a tertiary care referral hospital in Rwanda. Sensitivity and threshold analyses were performed to determine the robustness of the results. RESULTS: The laparoscopic and open cholecystectomy costs and effectiveness values were $2664.47 with 0.87 quality-adjusted life years (QALYs) and $2058.72 with 0.75 QALYs, respectively. The incremental cost-effectiveness ratio for laparoscopic over open cholecystectomy was $4946.18. Results are sensitive to the initial laparoscopic equipment investment and number of cases performed annually but robust to other parameters. The laparoscopic intervention is more cost-effective with investment costs less than $91,979, greater than 65 cases annually, or at willingness-to-pay (WTP) thresholds greater than $3975/QALY. CONCLUSIONS: At RMH, while laparoscopic cholecystectomy may be a more effective approach, it is also more expensive given the low caseload and high investment costs. At commonly accepted WTP thresholds, it is not cost-effective. However, as investment costs decrease and/or case volume increases, the laparoscopic approach may become favorable. Countries and hospitals should aspire to develop innovative, low-cost options in high volume to combat these barriers and provide laparoscopic surgery.
BACKGROUND: Laparoscopic cholecystectomy is first-line treatment for uncomplicated gallstone disease in high-income countries due to benefits such as shorter hospital stays, reduced morbidity, more rapid return to work, and lower mortality as well-being considered cost-effective. However, there persists a lack of uptake in low- and middle-income countries. Thus, there is a need to evaluate laparoscopic cholecystectomy in comparison with an open approach in these settings. METHODS: A cost-effectiveness analysis was performed to evaluate laparoscopic and open cholecystectomies at Rwanda Military Hospital (RMH), a tertiary care referral hospital in Rwanda. Sensitivity and threshold analyses were performed to determine the robustness of the results. RESULTS: The laparoscopic and open cholecystectomy costs and effectiveness values were $2664.47 with 0.87 quality-adjusted life years (QALYs) and $2058.72 with 0.75 QALYs, respectively. The incremental cost-effectiveness ratio for laparoscopic over open cholecystectomy was $4946.18. Results are sensitive to the initial laparoscopic equipment investment and number of cases performed annually but robust to other parameters. The laparoscopic intervention is more cost-effective with investment costs less than $91,979, greater than 65 cases annually, or at willingness-to-pay (WTP) thresholds greater than $3975/QALY. CONCLUSIONS: At RMH, while laparoscopic cholecystectomy may be a more effective approach, it is also more expensive given the low caseload and high investment costs. At commonly accepted WTP thresholds, it is not cost-effective. However, as investment costs decrease and/or case volume increases, the laparoscopic approach may become favorable. Countries and hospitals should aspire to develop innovative, low-cost options in high volume to combat these barriers and provide laparoscopic surgery.
Authors: Blake C Alkire; Nakul P Raykar; Mark G Shrime; Thomas G Weiser; Stephen W Bickler; John A Rose; Cameron T Nutt; Sarah L M Greenberg; Meera Kotagal; Johanna N Riesel; Micaela Esquivel; Tarsicio Uribe-Leitz; George Molina; Nobhojit Roy; John G Meara; Paul E Farmer Journal: Lancet Glob Health Date: 2015-04-27 Impact factor: 26.763
Authors: Tiffany E Chao; Ketan Sharma; Morgan Mandigo; Lars Hagander; Stephen C Resch; Thomas G Weiser; John G Meara Journal: Lancet Glob Health Date: 2014-05-21 Impact factor: 26.763
Authors: Derek E Moore; Irene D Feurer; Michael D Holzman; Leonard J Wudel; Carolyn Strickland; D Lee Gorden; Ravi Chari; J Kelly Wright; C Wright Pinson Journal: Arch Surg Date: 2004-05
Authors: John G Meara; Andrew J M Leather; Lars Hagander; Blake C Alkire; Nivaldo Alonso; Emmanuel A Ameh; Stephen W Bickler; Lesong Conteh; Anna J Dare; Justine Davies; Eunice Dérivois Mérisier; Shenaaz El-Halabi; Paul E Farmer; Atul Gawande; Rowan Gillies; Sarah L M Greenberg; Caris E Grimes; Russell L Gruen; Edna Adan Ismail; Thaim Buya Kamara; Chris Lavy; Ganbold Lundeg; Nyengo C Mkandawire; Nakul P Raykar; Johanna N Riesel; Edgar Rodas; John Rose; Nobhojit Roy; Mark G Shrime; Richard Sullivan; Stéphane Verguet; David Watters; Thomas G Weiser; Iain H Wilson; Gavin Yamey; Winnie Yip Journal: Lancet Date: 2015-04-26 Impact factor: 79.321
Authors: Mee Joo Kang; Kwabena Breku Apea-Kubi; Kojo Assoku Kwarko Apea-Kubi; Nyabenda-Gomwa Adoula; James Nii Noi Odonkor; Alfred Korbia Ogoe Journal: Ann Glob Health Date: 2020-07-30 Impact factor: 2.462