Abstract
BackgroundAs a common female pelvic tumor, uterine fibroids remain the leading cause for hysterectomy in China. Hysterectomy provides a good surgical treatment of uterine fibroids, and it guarantees the removal of all uterine fibroids without lower risk of recurrence. This study compares the cost effectiveness of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) for women with uterine fibroids from a societal perspective.MethodsAn economic analysis was conducted in 392 patients (TLH n = 75; TAH n = 317), including all relevant costs over a 12-month time horizon. Primary outcome was major surgical complications; secondary outcomes were postoperative discomfort symptoms and time of return to normal activities. Clinical, outcomes and costs data were collected from medical records, telephone survey and financial information system. Generalized linear models were used to assess costs and outcomes differences between the two groups. Incremental cost effectiveness ratio (ICER) was used to estimate the cost effectiveness.ResultsMean direct costs were $2,925.71 for TLH, $2,436.24 for TAH, respectively. Mean indirect costs were $1,133.22 for TLH, $1,394.85 for TAH, respectively. Incremental societal costs were $256.86 (95%CI: 249.03–264.69). Mean differences in outcome were: 4.53% (95%CI: 4.35–4.71) for major surgical complications; 6.75% (95%CI: 6.45–7.05) for postoperative discomfort symptoms; 1.27 (95%CI: 1.23–1.30) weeks for time to return to normal activities. ICER of TLH was $5,669.16 (95%CI: 5,384.76–5,955.56) per complication averted, $3,801.54 (95%CI: 3,634.81–3,968.28) per postoperative discomfort symptoms averted and $202.96 (95%CI: 194.97–210.95) per week saved to return to normal activities.ConclusionsTLH is cost effective compared with TAH in preventing additional complications based on our estimated conservative threshold in China. The findings provide useful information for researchers to conduct further cost effectiveness analysis based on prospective study which can provide stronger and more evidence, in China. In addition, the data may be useful for Chinese health care policy-makers and medical insurance payers to make related health care decisions.
Highlights
Uterine fibroids are the most common female pelvic tumor, causing lots of health risks of women [1,2,3]
There were no significant differences between the two groups in age, body mass index (BMI), number of births, previous delivery, menopause, size of fibroid, previous abdominal operation history, whether they used a contraceptive ring, severity on admission, comorbidities, insurance status, employment status or living location
There were no significant differences between the two groups in rate of major surgical complications or discomfort symptoms
Summary
Uterine fibroids are the most common female pelvic tumor, causing lots of health risks of women [1,2,3]. Hysterectomy is the most common nonpregnancy-related gynecologic surgical procedure performed worldwide, with rates of 3.62 per 1,000 women in Germany [7], 3.12 per 1,000 women in Australia [8], 5.1 per 1,000 in 2004 in the United States and 17 per 1,000 women in India [9] and uterine fibroids are the leading cause of hysterectomy [10, 11]. As a common female pelvic tumor, uterine fibroids remain the leading cause for hysterectomy in China. This study compares the cost effectiveness of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) for women with uterine fibroids from a societal perspective
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