Biliary lithotripsy versus cholecystectomy: a cost-utility analysis.

Evaluating the economic impact of medical procedures is of increasing importance in the American health care system, and this is especially true in the case of new medical technologies. Both the cost and the outcome of a treatment, and its alternatives must be evaluated. A cost-utility analysis was performed to compare cholecystectomy with biliary lithotripsy accompanied by bile acid therapy. Using a Markov approach, a model was designed to project expected cost and quality-adjusted survival over a 5-year period in patients with solitary stones of less than or equal to 20 mm in diameter. The viewpoint of the analysis was chosen to be that of the general society, since it can be considered as a consensus of all interest groups. Direct costs were obtained from hospitals in Atlanta, Georgia; indirect costs are based on average United States earnings. Utility was estimated using a model that combines different scales of well-being with an underlying etiology. The findings indicate that from society's point of view for all patients meeting lithotripsy inclusion criteria, based on this cost-utility analysis, biliary lithotripsy would be the procedure of choice.