[Cost comparison of laparoscopic cholecystectomy and extracorporeal shockwave lithotripsy in the treatment of gallstones].

To aid in the choice between laparoscopic cholecystectomy and extracorporeal shock wave lithotripsy for the treatment of gallstones the costs of the two methods were investigated. A decision tree was constructed so as to set out the initial procedure costs of both techniques and possible subsequent costs due to treatment failure or complications. The computations were based on figures from the University Clinic, Erlangen, in 1993. The direct (medical) costs of laparoscopic cholecystectomy amounted to DM 3556, to which must be added further indirect costs of DM 3152 arising from loss of working capacity and premature death. The direct expenses for lithotripsy including outpatient aftercare were DM 6708 and the indirect expenses DM 1858. The overall costs per patient for lithotripsy are hence DM 1858 higher than those of laparoscopic cholecystectomy. This cost difference remained substantially unaltered even when the success rates of the two techniques were varied over a wide range. When lithotripsy is performed entirely as an outpatient procedure and inpatient costs hence disappear, the expected overall cost drops from DM 8567 to DM 6381. Omission of the lump sum charge for lithotripsy effects a similar drop in overall costs to DM 6379. Laparoscopic cholecystectomy is hence cheaper than lithotripsy. Only if lithotripsy can be performed at very low cost can it compete with laparoscopic cholecystectomy.