Hospital cost categories of one-stage versus two-stage management of common bile duct stones

In the era of cost-conscious healthcare, hospitals are focusing on costs. Analysis of hospital costs per cost category may provide indications for potential cost-saving measures in the management of common bile duct stones (CBDS) with gallbladder in situ.

Between October 2005 and September 2006, 53 consecutive patients suffering from CBDS underwent either a one-stage procedure [laparoscopic common bile duct exploration (LCBDE) with stone clearance and cholecystectomy (LCCE)] or a two-stage procedure [endoscopic retrograde cholangiopancreatography with sphincterotomy and stone clearance (ERCP/ERS) followed by LCCE]. Costs were defined in different cost categories for each activity centre and were linked to the individual patient via the “bill of activities”. Only patients (n = 38) with an uneventful post-procedural course and with available cost data were considered for cost analysis. Total length of hospital stay (LOS) was 2 (0–6) days after one-stage and 8 (3–18) days after two-stage procedure (p < 0.0001).

Costs per patient were significantly (p < 0.0001) less after one-stage versus two-stage management, i.e. total hospital costs (€2,636 versus €4,608), hospitalisation costs (€701 versus €2,190), consumables/pharmacy (€645 versus €1,476) and para-medical personnel (€1,035 versus €1,860; p = 0.0002). Operation room (OR) costs were comparable for one-stage and two-stage management (€1,278 versus €1,232; p = 0.280). Total hospital costs during ERCP were €2,648 (€729–4,544), during LCCE without LCBDE were €2,101 (€1,033–4,269), and during LCCE with LCBDE were €2,636 (€1,176–4,235).

In the management of patients with CBDS and gallbladder in situ a one-stage procedure is associated with significantly less costs as compared with a two-stage procedure. From the economical point of view these patients should preferably be treated via a one-stage procedure as long as safety and efficacy of this approach are provided.