Laparoscopic Versus Open Cholecystectomy: A Cost–Effectiveness Analysis at Rwanda Military Hospital
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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.
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.
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.
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.
KeywordsGross Domestic Product Laparoscopic Cholecystectomy Laparoscopic Approach Incisional Hernia Investment Cost
MGS receives support from the GE Safe Surgery 2020 project and from the Steven and Carmella Kletjian Foundation.
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to declare.
- 12.Hussain A, Mahmood HK, Dulku K (2008) Laparoscopic cholecystectomy can be safely performed in a resource-limited setting: the first 49 laparoscopic cholecystectomies in Yemen. J Soc Laparoendosc Surg 12:71–76Google Scholar
- 20.Rwanda Military Hospital; Ministry of Defence. (2015). http://mod.gov.rw/about-the-mod/agencies-units/rwanda-military-hospital/#.VdysN2ZXenM. Accessed 10 Jan 2015
- 26.Hussain Talpur KA, Mahmood Malik A, Khan Sangrasi A et al (2011) Comparative study of conventional open versus laparoscopic cholecystectomy for symptomatic cholelithiasis. Pak J Med Sci 27(1):33–37Google Scholar
- 27.World Bank Purchasing Power Parity (2015) http://data.worldbank.org/indicator/PA.NUS.PRVT.PP. Accessed 17 Sep 2015
- 28.Choosing interventions that are cost-effective [Internet]. Geneva: World Health Organization (2016). http://www.who.int/choice/en/. Accessed 30 Jan 2016
- 29.The World Bank: Rwanda Data (2015) http://data.worldbank.org/country/rwanda#cp_wdi. Accessed Oct 9 2015
- 30.Indiamart: Laparoscopy Equipment from India (2016) http://dir.indiamart.com/impcat/laparoscopy-equipment.html. Accessed 1 Aug 2016
- 34.Mohamed MI, Abdalla AA, Alshaikh AA (2014) Laparoscopic cholecystectomy: a 15-years experience at a single centre: Wad Medani, Sudan. East Cent Afr J Surg 19(2):12–16Google Scholar