The cost-effectiveness of total laparoscopic hysterectomy compared to total abdominal hysterectomy for the treatment of early stage endometrial cancer

Abstract

ObjectiveTo summarise how costs and health benefits will change with the adoption of total laparoscopic hysterectomy compared to total abdominal hysterectomy for the treatment of early stage endometrial cancer.DesignCost-effectiveness modelling using the information from a randomised controlled trial.ParticipantsTwo hypothetical modelled cohorts of 1000 individuals undergoing total laparoscopic hysterectomy and total abdominal hysterectomy.Outcome measuresSurgery costs; hospital bed days used; total healthcare costs; quality-adjusted life years; and net monetary benefits.ResultsFor 1000 individuals receiving total laparoscopic hysterectomy surgery, the costs were $509 575 higher, 3548 hospital fewer bed days were used and total health services costs were reduced by $3 746 221. There were 39.13 more quality-adjusted life years for a 5 year period following surgery.ConclusionsThe adoption of total laparoscopic hysterectomy is almost certainly a good decision for health services policy makers. There is 100% probability that it will be cost saving to health services, a 86.8% probability that it will increase health benefits and a 99.5% chance that it returns net monetary benefits greater than zero.

Multimodal pain control is associated with reduced hospital stay following open abdominal hysterectomy

“…have been reported to have longer hospital stay -an average of 3.7 to 4.4 days [19,20] -but usually at a lower cost [21]. Our objective was to study the effectiveness of a multimodal pain control protocol (MMPC) in reducing post-hysterectomy hospital stay in uterine cancer patients undergoing staging by open abdominal hysterectomy.…”

How to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge IMAGINE trial

“…While high-level evidence is available to suggest that compared with less invasive approaches, TAH is associated with inferior health outcomes,3 11 15–20 22 a significant proportion of women still receive TAH. It has been proposed that increasing the adoption of TLH would reduce the rate of TAH and subsequently improve surgical outcomes as well as provide significant cost savings for funders of healthcare 7 30…”

“…TLH was developed to allow the surgery to be completed entirely laparoscopically,13 14 and has been shown to be feasible and safe; compared with TAH, TLH is associated with improved recovery, shorter hospital stay, reduced risk of surgical complications3 15–18 and equivalent disease-free outcomes for treating endometrial cancer 11 19–22. While TLH is a slightly more costly procedure than TAH, TLH has been shown to be cost-effective when the total cost of care is considered 7 19. Robotic hysterectomy is an alternative approach to hysterectomy used in some highly developed countries, especially the USA.…”

Postlaparoscopic Hysterectomy Discharge within 24 h in Hospital Putrajaya

“…Randomized trials have shown advantages of laparoscopy versus laparotomy, including reduced postoperative pain, shorter hospitalization, rapid recovery, and substantial financial benefits to the society. [ 2 ] Laparoscopic approach is also more superior in terms of better surgical field visualization and lesser intraoperative blood loss. [ 3 ] This approach clearly associated with fast speedier return to normal activities and fewer abdominal wall infections when compared with abdominal hysterectomy.…”