2023-09-28 14:46:10 +00:00
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abstract: 'Background Laparoscopic cholecystectomy is first-line treatment for
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uncomplicated gallstone disease in high-income countries due to benefits
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such as shorter hospital stays, reduced morbidity, more rapid return to
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work, and lower mortality as well-being considered cost-effective.
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However, there persists a lack of uptake in low- and middle-income
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countries. Thus, there is a need to evaluate laparoscopic
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cholecystectomy in comparison with an open approach in these settings.
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Methods A cost-effectiveness analysis was performed to evaluate
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laparoscopic and open cholecystectomies at Rwanda Military Hospital
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(RMH), a tertiary care referral hospital in Rwanda. Sensitivity and
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threshold analyses were performed to determine the robustness of the
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results.
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Results The laparoscopic and open cholecystectomy costs and
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effectiveness values were \$2664.47 with 0.87 quality-adjusted life
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years (QALYs) and \$2058.72 with 0.75 QALYs, respectively. The
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incremental cost-effectiveness ratio for laparoscopic over open
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cholecystectomy was \$4946.18. Results are sensitive to the initial
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laparoscopic equipment investment and number of cases performed annually
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but robust to other parameters. The laparoscopic intervention is more
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cost-effective with investment costs less than \$91,979, greater than 65
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cases annually, or at willingness-to-pay (WTP) thresholds greater than
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\$3975/QALY.
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Conclusions At RMH, while laparoscopic cholecystectomy may be a more
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effective approach, it is also more expensive given the low caseload and
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high investment costs. At commonly accepted WTP thresholds, it is not
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cost-effective. However, as investment costs decrease and/or case volume
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increases, the laparoscopic approach may become favorable. Countries and
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hospitals should aspire to develop innovative, low-cost options in high
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volume to combat these barriers and provide laparoscopic surgery.'
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affiliation: 'Shrime, MG (Corresponding Author), Harvard Med Sch, Program Global Surg
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\& Social Change, 641 Huntington Ave 411, Boston, MA 02115 USA.
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Silverstein, Allison; Costas-Chavarri, Ainhoa; Mukhopadhyay, Swagoto; Meara, John
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G.; Shrime, Mark G., Harvard Med Sch, Program Global Surg \& Social Change, 641
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Huntington Ave 411, Boston, MA 02115 USA.
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Silverstein, Allison, Univ Miami, Miller Sch Med, Miami, FL 33136 USA.
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Costas-Chavarri, Ainhoa; Gakwaya, Mussa R.; Lule, Joseph, Rwanda Mil Hosp, Kigali,
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Rwanda.
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Mukhopadhyay, Swagoto, Univ Connecticut, Dept Surg, Farmington, CT USA.
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Meara, John G., Boston Childrens Hosp, Dept Plast \& Oral Surg, Boston, MA USA.
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Shrime, Mark G., Massachusetts Eye \& Ear Infirm, Dept Otolaryngol, Boston, MA 02114
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USA.
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Shrime, Mark G., Massachusetts Eye \& Ear Infirm, Off Global Surg, Boston, MA 02114
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USA.'
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author: Silverstein, Allison and Costas-Chavarri, Ainhoa and Gakwaya, Mussa R. and
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Lule, Joseph and Mukhopadhyay, Swagoto and Meara, John G. and Shrime, Mark G.
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author-email: shrime@mail.harvard.edu
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author_list:
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- family: Silverstein
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given: Allison
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- family: Costas-Chavarri
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given: Ainhoa
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- family: Gakwaya
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given: Mussa R.
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- family: Lule
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given: Joseph
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- family: Mukhopadhyay
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given: Swagoto
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- family: Meara
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given: John G.
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- family: Shrime
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given: Mark G.
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da: '2023-09-28'
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doi: 10.1007/s00268-016-3851-0
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eissn: 1432-2323
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files: []
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issn: 0364-2313
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journal: WORLD JOURNAL OF SURGERY
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keywords-plus: BILE-DUCT; HEALTH; SURGERY; RECOMMENDATIONS; BENEFITS; MEDICINE
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language: English
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month: MAY
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number: '5'
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number-of-cited-references: '34'
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orcid-numbers: Meara, John G./0000-0003-4369-3209
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pages: 1225-1233
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papis_id: 5b89e1e69c8848606769e7f9347efeeb
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ref: Silverstein2017laparoscopicopen
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times-cited: '14'
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title: 'Laparoscopic Versus Open Cholecystectomy: A Cost-Effectiveness Analysis at
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Rwanda Military Hospital'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000399693400011
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usage-count-last-180-days: '0'
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usage-count-since-2013: '3'
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volume: '41'
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web-of-science-categories: Surgery
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year: '2017'
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