Summary
- Data were collected on the number of cholecystectomies undertaken in Canada and Australia over a number of years, before and after the introduction of laparoscopic cholecystectomy. Estimates were also made of the costs of these surgical procedures to health programs and to patients.
- The Canadian data on numbers and costs of cholecystectomies were based on surveys undertaken in hospitals in all provinces and territories. The Australian estimates were derived from national and State databases.
- In both countries, cholecystectomy rates were steady for some years prior to the introduction of laparoscopic cholecystectomy. After the new procedure became available, rates increased by 17% in Canada and 24% in Australia within two years.
- Use of the laparoscopic procedure led to a reduction in average length of stay (ALOS) for cholecystectomy cases, but in terms of impact on costs, this was partly offset by the increase in the number of procedures. The cost to health programs decreased marginally in both Canada and Australia.
- Days lost by patients because of surgery, and the associated costs of this, decreased in Canada by 17% and 15% respectively between 1989-90 and 1991-92. The corresponding decreases in Australia were 25% and 23%.
- Estimates of potential savings to health programs through the new method indicated that, while some gains had been made, the estimated potential savings from the use of the new method had not been achieved due to increases in caseload.
- Possible reasons for the increase in surgery rates include extension of services to frailer patients, use of surgery rather than conservative management, use in asymptomatic cases and inappropriate diagnosis.
- As ALOS and rates of conversion to open surgery associated with laparoscopic cholecystectomy decline, there will be an improvement in the savings achieved for health programs and for patients. However, if the higher rates of surgery are maintained, there will be continued uncertainty as to the utility of some of these additional procedures.
- The experience of Canada and Australia suggests that the introduction of laparoscopic cholecystectomy has produced benefits though these were less than optimum during the first two years that the technique was in use. The increases in the rates of cholecystectomies observed suggests the need for appropriate mechanisms to establish appropriate indications and clear guidelines for this and other minimal access surgical techniques.