Cost analysis of gynaecological endoscopy

Abstract

Objectives To determine whether gynaecological endoscopy is cost effective when compared with standard gynaecological techniques. Setting Hysterectomies, oöphorectomies, ovarian cystectomies and ectopic pregnancies were performed laparoscopically and by laparotomy at the Rockyview Hospital in Calgary, Alberta, Canada and the results were analysed. Design A total of 682 operations were assigned ‘resource intensity weight’ (RIW) and the ‘hospital cost per weight case’ was applied in order to determine the total cost if 100% of the procedures were carried out by laparotomy vs. 90% carried out laparoscopically and the remaining 10% by laparotomy. Personal experience and collaboration with other gynaecological laparoscopists indicated that at least 90%, if not more of these cases can be carried out laparoscopically. With this in mind, the financial saving to the hospital as well as potential number of inpatient beds saved were then calculated. Outcomes The cost of the 682 procedures if all had been performed by laparotomy was $1 819 286 (Canadian dollars). This compared with the cost of $519 874 when 90% of the operations were carried out laparoscopically and the remainder by laparotomy, for a saving of $1 299 412. The number of inpatient beds needed for the cases carried out by laparotomy was 10.75; potentially 7.69 of these beds are saved with 90% of the cases being carried out laparoscopically. Conclusion Endoscopic surgery is an effective method of reducing costs and the number of inpatient beds required.