A randomized clinical trial was undertaken to compare the effectiveness and direct costs of shock wave lithotripsy (ESWL) and laparoscopic cholecystectomy (LC) for the treatment of symptomatic gallbladder stones. Over a period of 24 months from a total of 468 patients screened, 35 patients were randomized to ESWL, and 25 to LC. 32 ESWL patients were treated, all as out-patients, with a mean convalescence post-ESWL of 0.5 $ pm$ 1.2 days. In contrast, all LC patients were admitted to hospital for a mean duration of 2.8 $ pm$ 1.5 days with a mean post-operative convalescence of 18.2 $ pm$ 16.8 days as measured by research nurses. The two patient groups did not differ with respect to McGill Pain scores administered immediately after treatment. Three Quality of Life (QOL) tools improved similarly in both groups within the month following treatment. The only differences in QOL questionnaire results between both groups when administered 3 months following treatment and at six monthly intervals thereafter occurred for LC as greater incremental improvements were noted at 6 and 12 months follow-up. The overall stone disappearance rate in the ESWL group after a median of 15 months was 38%. Direct costs to the Quebec Health Care system during the study period were determined by analysis of patients in both treatment groups. In 1993 canadian dollars, average costs and their range were 2,889$ (1,704 $-5,830$) for patients undergoing LC, and 3,936 $ (2,367$--6,243 $) for patients treated by ESWL. The cost effectiveness ratios using the incremental differences in direct costs and duration of disability favoured ESWL at a cost of 58.9$/day of disability saved over the 15--18 months follow-up period. (Abstract shortened by UMI.)
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:QMM.22717 |
| Date | January 1995 |
| Creators | Barkun, Alan N. (Alan Nicolas Glen) |
| Contributors | Grover, Steven (advisor) |
| Publisher | McGill University |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Format | application/pdf |
| Coverage | Master of Science (Department of Epidemiology and Biostatistics.) |
| Rights | All items in eScholarship@McGill are protected by copyright with all rights reserved unless otherwise indicated. |
| Relation | alephsysno: 001453417, proquestno: MM05529, Theses scanned by UMI/ProQuest. |
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