The impact of new technology on cholecystectomy rates in New South Wales

Abstract

This study examined the impact of the introduction of laparoscopic cholecystectomy (LC) on the rate and pattern of cholecystectomy in New South Wales, Australia. An analysis of the hospital data for the period 1981-94/95 was performed, which encompassed patients of both public and private hospitals. Cholecystectomy rates in the years after the introduction of LC in mid-1990 were 24% higher on average than rates in the prior years and rose from an average 1.68-2.09 per 1000. In the 5-year period of the study after the introduction of LC, the average age of private hospital patients increased from 50.6 to 53.4 years, while that of public hospital patients declined slightly from 53.5 to 52.4 years. Laparoscopic cholecystectomy was introduced more rapidly in private than public hospitals. By June 1995, 96% of private compared with 71% of public hospitals had introduced LC, and cholecystectomy patients in private hospitals were more likely to have laparoscopic surgery than patients in public hospitals (92% compared with 80%). The introduction of LC has been accompanied by a marked and sustained increase in the cholecystectomy rate. While the unit cost for the laparoscopic procedure is lower because of a shorter length of stay, the increase in the number of procedures means that there have been no net savings for the health system from the increased efficiency. While the new procedure offers superior advantages to patients with symptomatic gallbladder disease, the effect of the apparent lower threshold for surgery needs investigation.