Cost-Effectiveness of Office Hysteroscopy for Abnormal Uterine Bleeding

Abstract

Background and Objectives:Office diagnostic hysteroscopy allows physicians to directly view the endometrial cavity, tubal ostia, and endocervical canal without taking the patient to the operating room (OR). We sought to determine whether office hysteroscopy performed to evaluate abnormal uterine bleeding decreases the need for hysteroscopy performed in the OR and the associated financial and risk implications.Methods:One hundred thirty patients who underwent office diagnostic hysteroscopy between January 2009 and March 2012 at 2 outpatient clinics in an academic university setting were identified. Records were reviewed from paper charts and electronic medical records. Hospital charts for patients who required hysteroscopy in the OR were reviewed as well. Charge estimates were obtained from our billing department. These results were analyzed for review of the data.Results:Seventy-five of the 130 women who underwent diagnostic office hysteroscopy for abnormal bleeding did not need to undergo hysteroscopy in the OR. This represents estimated savings of $1498 per patient (95% confidence interval, $1051–$1923) in procedure charges. Among the 55 women who underwent OR hysteroscopy, there was 71% agreement between findings on hysteroscopy in the office and in the OR.Conclusion:Office hysteroscopy is a useful diagnostic tool that can help decrease the rate of diagnostic hysteroscopy in the OR under anesthesia when used in a select patient population.

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“…Hysteroscopy plays a crucial role in the evaluation of the uterine cavity in women with abnormal uterine bleeding and infertility, and evolution in both the procedure itself and the instrument has enabled its use in the office context . As an office procedure, it gives comparable results to inpatient hysteroscopy, with the advantages of lower costs and avoidance of anesthetic risks …”

The impact of altering filling pressures in diagnostic outpatient hysteroscopy on the procedure completion rates and associated pain: a randomised double‐blind controlled trial

“…Hysteroscopy is currently the most informative investigation for women with abnormal uterine bleeding and uterine factor infertility . Outpatient hysteroscopy is comparable with surgical inpatient hysteroscopy but offers reduced anaesthesia risks and decreased overall costs . It involves the use of miniaturised endoscopic equipment to directly visualise the endometrial cavity without the need for formal operating room facilities or anaesthesia …”

The role of hysteroscopy in diagnosis of menstrual disorders

“…Outpatient hysteroscopy has been shown to be safe and acceptable to women. Research has shown that the outpatient approach is more cost-effective, and patients value the convenience of an immediate diagnosis [9,10]. This allows women to be counselled about their treatment options, thus avoiding lengthy follow-up appointments.…”