Cost effectiveness analysis of total laparoscopic hysterectomy versus total abdominal hysterectomy for uterine fibroids in Western China: a societal perspective

Abstract

Background As 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. Methods An 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. Results Mean 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. Conclusions TLH 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.

A Comparison between Total Abdominal Hysterectomy versus Total Laparoscopic Hysterectomy

“…Most studies found no difference in the incidence of urinary tract injuries between TLH and TAH. [ 2 18 19 ] A systematic review also found a 0.14% rate of bladder or ureter injuries (122 cases) among 86,683 TLH patients. [ 20 ]…”

“…Since 2010, hysterectomy has been the most common nonpregnancy-related gynecological operation worldwide. [ 1 2 ] The standard approach is total abdominal hysterectomy (TAH). [ 1 ] However, various techniques are currently being implemented to decrease patient morbidity, caregiver burden, and inhospital stay.…”

“…[ 1 ] However, various techniques are currently being implemented to decrease patient morbidity, caregiver burden, and inhospital stay. [ 2 ] Among them, minimally invasive surgeries (total laparoscopic hysterectomy [TLH]) are favored by many clinicians. This emerging procedure benefits some aspects of patients’ quality of life.…”

Comparison of hysterectomy and uterine artery embolization in the treatment of symptomatic uterine fibroids: A protocol for systematic review and meta-analysis

“…Hysterectomy has traditionally been the primary approach for the management of symptomatic fibroids and remains the only definitive treatment available. [ 9 ] Uterine artery embolization, which is usually performed while the patient is under local anesthesia, involves temporary occlusion of the arteries supplying the uterus, with the use of biocompatible particles, to cause ischemic infarction of the fibroids. [ 10 ] As compared with hysterectomy, uterine artery embolization is associated with a shorter hospital stay and an earlier return to normal activities but also a higher likelihood of the need for additional intervention.…”