The results of the economic evaluation suggest that , on average , the surgery strategy costs £ 1236 more per patient than the conservative management strategy but was , on average , more effective .
An increase in the number of people requiring surgery while treated conservatively corresponded to a reduction in the cost-effectiveness of the conservative strategy .
The results of this assessment indicate that cholecystectomy is still the treatment of choice for many symptomatic people .
However , approximately half of the people in the observation group did not require surgery or suffer complications in the long term indicating that a conservative therapeutic approach may represent a valid alternative to surgery in this group of people .
BACKGROUND Approximately 10 - 15 % of the adult population suffer from gallstone disease , cholelithiasis , with more women than men being affected .
Cholecystectomy is the treatment of choice for people who present with biliary pain or acute cholecystitis and evidence of gallstones .
However , some people do not experience a recurrence after an initial episode of biliary pain or cholecystitis .
As most of the current research focuses on the surgical management of the disease , less attention has been dedicated to the consequences of conservative management .
OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of  cholecystectomy  compared with observation/conservative management in people presenting with uncomplicated symptomatic gallstones ( biliary pain ) or cholecystitis .
Randomization to surgery or observation in patients with symptomatic gallbladder stone disease. The problem of evidence-based medicine in clinical practice.
BACKGROUND The description and underst and ing of gallbladder stone disease in the medical literature are difficult because an assessment of the natural course of this symptomatic disease , with separation of patients in strictly defined groups , is generally lacking . METHOD A multicenter study was carried out with patients r and omized to either surgery or conservative , expectant treatment to examine optimal treatment and natural history in well-defined groups of symptomatic gallbladder stone disease with pain , episodes only ( study group 1 ) or acute cholecystitis ( study group 2 ) . The patients were between 18 and 80 years of age and had right upper quadrant or midline epigastric pain and ultrasonographic evidence of gallbladder stone , with or without acute cholecystitis . Medical treatment was ordinated on the basis of signs and symptom severity . Patients r and omized to surgery  were placed on the hospital 's waiting list and electively operated on with cholecystectomy as soon as conveniently possible . Preliminary results of follow-up are based on question naires mailed at regular intervals and consultations if required by the patients ' symptoms . Quality of life and freedom from pain are study end points for evaluation . RESULTS Five hundred and one patients were considered for the study , 318 patients ( 63.5 % ) belonging to group 1 and 183 ( 36.5 % ) to group 2 . One hundred and eighty-four patients ( 36.7 % ) were r and omized , 120 ( 24 % ) in group 1 and 64 ( 12.7 % ) in group 2 . Three hundred and seventeen patients ( 63.3 % ) , with an equal proportion from each study group , were excluded , the largest number of patients because of incapacitating pain or serious presenting symptoms ( 26 % ) . More women ( 81 % ) than men ( 19 % ) had pain alone ( group 1 ) , but the sex ratio was reduced , 56 % women and 44 % men , in patients with acute cholecystitis ( group 2 ) , with a highly significant difference ( P = < 0.001 ) between the two groups . A significant difference in patient withdrawal from r and omized treatment was registered , with 24 % from observation and 12 % from surgery ( P = 0.032 ) , but with an equal distribution in the two study groups . CONCLUSIONS A r and omized trial of this nature is feasible but extremely difficult to perform because of the heterogeneous nature of gallbladder stone disease , leading to exclusion of many patients and difficulties in measuring and evaluating outcome variables
The results of the economic evaluation suggest that , on average , the surgery strategy costs £ 1236 more per patient than the conservative management strategy but was , on average , more effective .
An increase in the number of people requiring surgery while treated conservatively corresponded to a reduction in the cost-effectiveness of the conservative strategy .
The results of this assessment indicate that cholecystectomy is still the treatment of choice for many symptomatic people .
However , approximately half of the people in the observation group did not require surgery or suffer complications in the long term indicating that a conservative therapeutic approach may represent a valid alternative to surgery in this group of people .
BACKGROUND Approximately 10 - 15 % of the adult population suffer from gallstone disease , cholelithiasis , with more women than men being affected .
Cholecystectomy is the treatment of choice for people who present with biliary pain or acute cholecystitis and evidence of gallstones .
However , some people do not experience a recurrence after an initial episode of biliary pain or cholecystitis .
As most of the current research focuses on the surgical management of the disease , less attention has been dedicated to the consequences of conservative management .
OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of  cholecystectomy  compared with observation/conservative management in people presenting with uncomplicated symptomatic gallstones ( biliary pain ) or cholecystitis .