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Cost-Savings Analysis of Routine Hysteroscopy for Early Detection and Treatment of Intrauterine Adhesions

Anna Zelivianskaia, Arthur Arcaz, Paul Kolm, James K. Robinson, Nicholas Hazen
Published: 5 December 2022

Abstract:Objective: Many uterine procedures cause intrauterine adhesions (IUAs). The standard of care (SOC) for detecting IUAs includes initiating a work-up after a patient reports such symptoms as menstrual irregularity, pelvic pain, or infertility. Routine hysteroscopy (RHSC) is not currently performed after an event that may cause an IUA. This study objective was to determine if routine diagnostic HSC following procedures that are high risk for causing IUAs could be a cost-saving alternative to the current SOC from both medical-system and patient perspectives. Materials and Methods: This nonclinical economic-modeling exercise involved a hypothetical cohort of women who received office RHSC after an inciting event, compared to women who received SOC. The model had 4 scenarios for a range of diagnostic work-up costs and costs of HSC lysis of adhesions of varying severity. Each scenario was run with a proportion of IUA formation after an inciting event varying from 1% to 99%. Results: Costs of RHSC became equivalent to the SOC with an IUA incidence rate from 5% to 22%, depending on the cost of the work-ups. For less expensive work-ups, RHSC yielded cost savings of 18%–22%, with an IUA rate depending on the HSC treatment costs. For more expensive work-ups, including full infertility work-ups, RHSC provided cost savings for only 5% of IUAs in a given cohort of patients. Conclusions: The model demonstrated that RHSC after a procedure known to cause IUAs can be cost-saving in many clinical scenarios. Accounting for various infertility work-up cost estimates and gradients of adhesion severity, RHSC costs were equivalent to SOC with an IUA formation rate of 5%–22%. This suggests that RHSC could be considered in reproductive-age women who desire fertility after procedures known to cause IUAs, without expected increased costs to the medical system. Additionally, RHSC may confer health benefits and increase patient satisfaction due to earlier diagnosis and less loss of reproductive years. (J GYNECOL SURG 20XX:000)
Keywords: Asherman's syndrome / intrauterine adhesions / office hysteroscopy / infertility

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