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A retrospective study of all records of patients operated on for biliary lithiasis during the years 1995, 1996 and 1997 was performed in a general hospital setting to compare the costs of management according to presentation. This study shows that acute and chronic cholecystitis have statistically significantly different costs. The reimbursement plans, base on diagnostic related groups do not take this into account. This system disadvantages those centers which preferentially treat acute pathologies.

The purpose of this study was to assess the relevance of a medico-economic evaluation of gallstones. In other words, would it be possible to define economic criteria that would permit to select the best therapeutic method whilst respecting medical ethics? The frequency of gallstones, the high consumption of goods and medical services they require and the important loss of productivity that ensues justify this approach. The medical literature and a number of experts have made it possible to evaluate the advantages and drawbacks of each therapeutic method by defining its indications according to criteria of effectiveness such as duration of survival, quality of life of asymptomatic patients, gallbladder clearance, etc. We have tried to find out whether the introduction of medico-economic criteria in this pathology was likely to modify the various therapeutic methods available at present. We give here three examples. The first one is that of asymptomatic gallstones where the introduction of a cost/effectiveness ratio let to the conclusion that abstention is better than surgical treatment. The second example is a comparison of costs between cholecystectomy and medical treatment in high risk patients; the result was that surgery is preferable at the age of 50 years and medical treatment from 70 years onward. Finally, a comparison between surgery and lithotrity including the cost/effectiveness ratio concluded in favour of surgery. However, ethical, methodological and conceptual problems taking into account the value of human life, the difficulty to evaluate the quality of life and exterior incitations make it necessary to moderate the practical applications of these results.

A medical audit was conducted in a Paris hospital on patients who, in 1975, underwent cholecystectomy for uncomplicated gallstones. The audit comprised the duration of pre- and post-operative hospitalisation, the Social Security grading of medical acts, biochemical and radiological examinations and the quality of medical care, as assessed by morbidity and mortality rates. The results were brought to the knowledge of all members of the surgical team concerned. Similar studies conducted two and five years later showed that self-restriction on the part of the physicians resulted in improved costs through shorter stays in hospital (especially before surgery) and less extensive and numerous examinations, the incidence of complications remaining the same.