Delivering an effective outpatient service in gynaecology

Abstract

Objective To examine the cost implications of outpatient versus daycase hysteroscopy to the National Health Service, the patient and their employer. Design and interventions Randomised controlled trial.Setting The gynaecology clinic of a large teaching hospital.Participants Ninety-seven women with abnormal uterine bleeding requiring investigation.Methods Women were randomly allocated to either outpatient or daycase hysteroscopy. They were asked to complete diaries recording expenses and time off work. The National Health Service costs were calculated for a standard outpatient and daycase hysteroscopy. Main outcome measures Costs to the National Health Service, costs to the employer, loss of income, childcare costs and travel expenses. Results The outpatient group required significantly less time off work compared with the daycase group (0.8 days vs 3.3 days), P < 0.001. Of those women who lost income due to the hysteroscopy, the average loss of income was twice as much in the daycase group (£20.40 in the outpatient group vs £50.60 in the daycase group). The average cost of childcare required to cover the time spent in hospital undergoing the hysteroscopy was similar in both groups, however, the number of women requiring childcare was small. Travel costs incurred by the women were 74% more in the daycase group compared with the outpatient group -with an average cost of £3.46 in the outpatient group and £6.02 in the daycase group. Daycase hysteroscopy costs the National Health Service approximately £53.88 more per patient, than performing an outpatient hysteroscopy. Purchasing the hysteroscopes necessary to perform an outpatient hysteroscopy is a more expensive outlay than those required for daycase hysteroscopy. However, there are so many other savings that only 38 patients need to undergo outpatient hysteroscopy (even with a 4% failure rate) rather than daycase hysteroscopy in order to recoup the extra money required to set up an outpatient hysteroscopy service. Conclusion Outpatient hysteroscopy offers many benefits over its traditional counterpart including faster recovery, less time away from work and home and cost savings to the woman and her employer and the National Health Service. Resources need to be made available to rapidly develop this service across the UK in order to better serve both patient and taxpayer.

Twelve-Month Outcomes for Patients Undergoing Hysteroscopic Morcellation of Uterine Polyps and Myomas in an Office or Ambulatory Surgical Center

“…Lindheim et al [25] calculated that office-based hysteroscopy may represent a cost saving of at least 50% compared with hospital procedures. Likewise, Marsh et al [30] noted that outpatient hysteroscopy offered significant cost savings to both the woman and her employer. As health care systems become increasingly cost conscious, and new health care payment paradigms emerge, these and other potential economic benefits of office-based hysteroscopic morcellation should be evaluated.…”

Operative hysteroscopy in the outpatient setting: its role within a gynaecology service

“…Combined with endometrial curettage or pipelle endometrial biopsy, "outpatient" hysteroscopy had similar effectiveness to hysteroscopy under general anaesthetic and curettage [5] in diagnosing generalised pathology such as endometrial hyperplasia. It was well tolerated [6] and cost-efficient [7]. Furthermore, with the development of operative hysteroscopes, directed biopsy and treatment can now be performed in the outpatient setting, resulting in excellent diagnosis of focal lesions [8,9].…”

Inpatient and outpatient loop electrosurgery excision procedure for cervical intraepithelial neoplasia: a retrospective analysis

“…However, there is no such evaluation of cost-effectiveness in the literature, with regard to hysteroscopy, which also can be performed as an in-and outpatient procedure, a British study estimated 50% reductions in cost for outpatient management compared to short hospital stay [15].…”