abstract: 'Background Laparoscopic cholecystectomy is first-line treatment for

  uncomplicated gallstone disease in high-income countries due to benefits

  such as shorter hospital stays, reduced morbidity, more rapid return to

  work, and lower mortality as well-being considered cost-effective.

  However, there persists a lack of uptake in low- and middle-income

  countries. Thus, there is a need to evaluate laparoscopic

  cholecystectomy in comparison with an open approach in these settings.

  Methods A cost-effectiveness analysis was performed to evaluate

  laparoscopic and open cholecystectomies at Rwanda Military Hospital

  (RMH), a tertiary care referral hospital in Rwanda. Sensitivity and

  threshold analyses were performed to determine the robustness of the

  results.

  Results The laparoscopic and open cholecystectomy costs and

  effectiveness values were \$2664.47 with 0.87 quality-adjusted life

  years (QALYs) and \$2058.72 with 0.75 QALYs, respectively. The

  incremental cost-effectiveness ratio for laparoscopic over open

  cholecystectomy was \$4946.18. Results are sensitive to the initial

  laparoscopic equipment investment and number of cases performed annually

  but robust to other parameters. The laparoscopic intervention is more

  cost-effective with investment costs less than \$91,979, greater than 65

  cases annually, or at willingness-to-pay (WTP) thresholds greater than

  \$3975/QALY.

  Conclusions At RMH, while laparoscopic cholecystectomy may be a more

  effective approach, it is also more expensive given the low caseload and

  high investment costs. At commonly accepted WTP thresholds, it is not

  cost-effective. However, as investment costs decrease and/or case volume

  increases, the laparoscopic approach may become favorable. Countries and

  hospitals should aspire to develop innovative, low-cost options in high

  volume to combat these barriers and provide laparoscopic surgery.'
affiliation: 'Shrime, MG (Corresponding Author), Harvard Med Sch, Program Global Surg
  \& Social Change, 641 Huntington Ave 411, Boston, MA 02115 USA.

  Silverstein, Allison; Costas-Chavarri, Ainhoa; Mukhopadhyay, Swagoto; Meara, John
  G.; Shrime, Mark G., Harvard Med Sch, Program Global Surg \& Social Change, 641
  Huntington Ave 411, Boston, MA 02115 USA.

  Silverstein, Allison, Univ Miami, Miller Sch Med, Miami, FL 33136 USA.

  Costas-Chavarri, Ainhoa; Gakwaya, Mussa R.; Lule, Joseph, Rwanda Mil Hosp, Kigali,
  Rwanda.

  Mukhopadhyay, Swagoto, Univ Connecticut, Dept Surg, Farmington, CT USA.

  Meara, John G., Boston Childrens Hosp, Dept Plast \& Oral Surg, Boston, MA USA.

  Shrime, Mark G., Massachusetts Eye \& Ear Infirm, Dept Otolaryngol, Boston, MA 02114
  USA.

  Shrime, Mark G., Massachusetts Eye \& Ear Infirm, Off Global Surg, Boston, MA 02114
  USA.'
author: Silverstein, Allison and Costas-Chavarri, Ainhoa and Gakwaya, Mussa R. and
  Lule, Joseph and Mukhopadhyay, Swagoto and Meara, John G. and Shrime, Mark G.
author-email: shrime@mail.harvard.edu
author_list:
- family: Silverstein
  given: Allison
- family: Costas-Chavarri
  given: Ainhoa
- family: Gakwaya
  given: Mussa R.
- family: Lule
  given: Joseph
- family: Mukhopadhyay
  given: Swagoto
- family: Meara
  given: John G.
- family: Shrime
  given: Mark G.
da: '2023-09-28'
doi: 10.1007/s00268-016-3851-0
eissn: 1432-2323
files: []
issn: 0364-2313
journal: WORLD JOURNAL OF SURGERY
keywords-plus: BILE-DUCT; HEALTH; SURGERY; RECOMMENDATIONS; BENEFITS; MEDICINE
language: English
month: MAY
number: '5'
number-of-cited-references: '34'
orcid-numbers: Meara, John G./0000-0003-4369-3209
pages: 1225-1233
papis_id: 5b89e1e69c8848606769e7f9347efeeb
ref: Silverstein2017laparoscopicopen
times-cited: '14'
title: 'Laparoscopic Versus Open Cholecystectomy: A Cost-Effectiveness Analysis at
  Rwanda Military Hospital'
type: Article
unique-id: WOS:000399693400011
usage-count-last-180-days: '0'
usage-count-since-2013: '3'
volume: '41'
web-of-science-categories: Surgery
year: '2017'