An economic evaluation of transcervical endometrial resection versus abdominal hysterectomy for the treatment of menorrhagia

Abstract

Objective To evaluate the relative health service cost of endometrial resection versus abdominal hysterectomy for the treatment of menorrhagia and the value women attach to their health state before and after surgery. Design A prospective economic evaluation running alongside a randomised controlled trial. Setting The gynaecology department of a teaching hospital. Subjects 200 women requiring surgical treatment of menorrhagia between January 1990 and May 1991; after withdrawals, 97 women underwent hysterectomy and 99 underwent endometrial resection. Main outcome measures The total health service cost of managing women in the two arms of the trial until 4 months after their operation. The change in women's valuation of their health state a fortnight after and a minimum of 4 months after surgery relative to that 1 month prior to their operation. Results Total health service costs are significantly higher amongst abdominal hysterectomy patients (mean £1059.73) than amongst endometrial resection patients with a mean difference of £499.68 (95% CI £432–£567). This significant difference exists under alternative assumptions about the difference in lengths of stay in hospital between the two treatment groups and the hotel cost per in-patient day. On a scale of 0 to 100, relative to a month before surgery, there is a statistically significant difference in favour of endometrial resection between the two groups in the increase in value women attach to their health state at a fortnight after surgery (mean difference 11.2; 95% CI 0.6–21.7), but not at a minimum of 4 months after surgery (mean difference 7; 95% CI –17.4 to 3.4). Conclusions On the basis of health service resource cost up to 4 months after surgery, endometrial resection has a cost advantage over abdominal hysterectomy. However, given the fact that a subgroup of women requires retreatment due to resection failure and that this study considers a relatively short period of follow up, the long term costs and benefits of endometrial resection need to be evaluated before widespread diffusion is justified.