Gallstone lithotripsy vs cholecystectomy. A preliminary cost-benefit analysis

J. G. Rothschild, R. F. Holbrook and R. B. Reinhold
New England Medical Center, Boston, Mass.

From July 1988 to January 1989, we compared the course of 48 patients undergoing elective cholecystectomy with that of 18 undergoing extracorporeal shock wave lithotripsy for symptomatic cholelithiasis with respect to treatment, hospitalization, recovery, and cost. For elective cholecystectomy, average length of surgery was 76 minutes (range, 31 to 186 minutes); average length of stay was 4 days; total cost was $6240; morbidity was 10%; and return to work averaged 5 weeks. Average extracorporeal shock wave lithotripsy treatment length was 136 minutes (80 to 158 minutes); average length of stay was 2 days; total cost was $5921; and hematuria and petechiae were seen in 33% and 28%, respectively. Re-treatment cost was $4880. All of these patients were active in 24 hours; return to work averaged 3 days. As results of the Food and Drug Administration study are still pending, recurrence and re-treatment rates are unknown. We conclude that extracorporeal shock wave lithotripsy is less costly, initially, with further reductions probable when performed on an outpatient basis. Though re-treatment may be required, return to normal activity is dramatically shortened.