Randomised trial comparing hysterectomy and transcervical endometrial resection: effect on health related quality of life and costs two years after surgery

Abstract

Objective To compare the impact of endometrial resection and abdominal hysterectomy on a range of health outcomes and health service costs, based on longer term follow up of patients randomised to a clinical trial.Design A parallel group randomised control trial. SettingThe gynaecology department of a teaching hospital.Participants 196 women requiring surgical treatment for menorrhagia were randomised and received surgery (88 underwent resection and 97 hysterectomy). Longer term follow up was undertaken using a postal questionnaire sent to all 196 women. Main outcome measuresLonger term assessment was on the basis of menstrual symptoms, health related quality of life using the Short Form 36 (SF36) and the EuroQoP visual analogue scale, patient satisfaction and health service resource cost. ResultsOf 196 women who were sent a questionnaire, 155 (79 %) responded at an average interval of 2.8 years after initial surgery. All aspects of health outcomes were as good or better in patients randomised to hysterectomy. Among patients randomised to resection, 57 % had experienced no improvement in premenstrual symptoms following surgery and 23 YO had taken time off work due to menstrual problems; among hysterectomy patients, these rates were 23 Yo and YO, respectively. Women randomised to hysterectomy had better mean scores on seven of the eight dimensions of the SF36 health related quality of life instrument, with the greatest difference being on the pain dimension ( P = 0.01). Women randomised to hysterectomy were generally more satisfied with treatment ( P = 0.002). By two years after initial surgery, women randomised to resection had a 12% probability of having had a repeat resection and a 16% chance of having had a hysterectomy. As a percentage of the mean total cost associated with women randomised to hysterectomy, the mean total cost of resection was 53 O h based on four months follow up; this proportion had increased to 71 YO, based on an average overall follow up of 2.2 years.Conclusions These results show that, at an average follow up of 2 8 years among responders to a questionnaire, women randomised to hysterectomy experienced more of an improvement in menstrual symptoms and higher rates of satisfaction with treatment. There is also some evidence of superior health related quality of life amongst hysterectomy patients. However, the health service cost of endometrial resection remains lower than that of hysterectomy. An assessment of the relative cost effectiveness of the two procedures awaits further research.

Transcervical Resection of Endometrium — Will it edge out Hysterectomy

“…The main advantage of hysterectomy over TCRE is that it guarantees amenorrhea and leads to high patient satisfaction levels. The TCRE also produced amenorrhea in 44.4% and hypomenorrhea in 44.4% and patient satisfaction levels in this study with TCRE are as good as they are in some other contemporary studies [4,7]. TCRE also led to disappearance of dysmenorrhea and premenstrual symptoms in majority of our patients.…”

“…It has been shown that when performed in experienced hands or when under supervision, TCRE procedure is superior to hysterectomy in terms of intra and post operative morbidity [3,4]. The rate of uterine perforation was higher as compared to other reports which is explained by the fact that practically all perforations occurred in the initial phase, were recognised and managed laparoscopically [5], the high incidence of minor morbidity, principally infection, in the hysterectomy group is similar to that previously reported.…”

Comparative study on specimen of Hysterectomy

“…The result is similar to several other studies. Zeba 52% 8 , Akhter 45% 9 ,Shergill et al 60% 10 , Sculpner et al 64% 11 . Analysis of the symptoms dysmenorrhoea came next to menorrhagia.…”

Utilità e costo/efficacia del dinoprostone in ostetricia

“…La parte di valutazione economica dei due regimi è stata condotta sulla base dei dati raccolti nella cartella clinica, da cui è stato possibile ricavare le quantità di risorse sanitarie consumate da cia- scuna coppia madre-neonato. I costi unitari dei singoli interventi medici sono stati calcolati sulla base delle indicazioni dell'amministrazione ospedaliera, mentre per le tariffe professionali dello staff medico sono state utilizzate le stime di Sculpher et al (18). I risultati dell'analisi economica (tabella 4) hanno indicato che nelle nullipare vi è poca differenza tra i due regimi di somministrazione di dinoprostone per quanto riguarda i costi delle cure perinatali, mentre i costi dovuti alla permanenza nei reparti pre-parto, post-parto e in sala parto sono risultati maggiori con il regime di monosomministrazione; in compenso, questo regime è risultato associato a minori spese per le cure pediatriche del neonato.…”