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Treatment of Symptomatic Cholelithiasis in France: A Decision Analysis Comparing Cholecystectomy and Biliary Lithotripsy

Published online by Cambridge University Press:  10 March 2009

A. Mark Fendrick ,
Gérard De Pouvourville ,
Caterine Bitker  and
Gilles Pelletier
A. Mark Fendrick
Affiliation:
École Polytechnique and Assistance, Publique—Hôpitaux de Paris
Gérard De Pouvourville
Affiliation:
École Polytechnique
Caterine Bitker
Affiliation:
Assistance Publique — Hôpitaux de Paris
Gilles Pelletier
Affiliation:
Assistance Publique — Hôpitaux de Paris
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Abstract

To determine the potential role of extracorporeal shock wave lithotripsy (ESWL) in the treatment of symptomatic gallstone patients in France, a simulation model evaluated the health and economic effects of three different treatment strategies. Decision analysis of conventional cholecystectomy alone and either of two strategies using a combination of biliary lithotripsy and conventional cholecystectomy reveals that a strategy employing biliary ESWL results in a significant number of successfully treated patients, thus avoiding the risks and costs of abdominal surgery. Moreover, cost analysis shows that expanding the use of lithotripsy to all patients for whom the procedure is indicated increases the average cost per successfully treated patient, but, more importantly, decreases the overall costs incurred by the cohort. From a societal viewpoint, a policy using biliary ESWL in appropriate patients is superior to one of cholecystectomy alone, from both clinical and economic perspectives.

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 8 , Issue 1 , Winter 1992 , pp. 166 - 184
Copyright
Copyright © Cambridge University Press 1992

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