title: Economic Evaluation of Hysteroscopic Endometrial Ablation versus Vaginal Hysterectomy for Menorrhagia
abstract: Between June 1992 and July 1993, 40 women with menorrhagia underwent vaginal hysterectomy, performed by 5 surgeons in one hospital. The patients were retrospectively compared with the first 40 women having endometrial ablation for menorrhagia performed during the same period by senior author. The age, parity, weight, and uterine size were similar in both groups. Measurable costs were surgical time, procedure time (anesthetist and resource use in operating room), length of hospital stay, convalescence (value of patient time), and indirect costs associated with subsequent surgical procedures. Measurable benefits were estimated blood loss, complications, and effectiveness of the procedure. The total cost per episode of care was estimated to be $5373 and $2279 (1995 $ Canadian) for vaginal hysterectomy and hysteroscopic endometrial ablation, respectively, for a mean saving of $3094. The benefits derived from both procedures were comparable. Vaginal hysterectomy eliminated bleeding in 100% of women and was associated with a complication rate of 41%. Endometrial ablation eliminated or improved bleeding in 90% of women (amenorrhea 46%, hypomenorrhea 35%, eumenorrhea 9%, no significant change 10%), was associated with no complications, and resulted in 82% satisfaction. Endometrial ablation is 82% effective and 58% less expensive than vaginal hysterectomy for the treatment of women with menorrhagia.
authors.affiliation: Department of Obstetrics and Gynecology, St. Joseph's Health Centre, 268 Grosvenor St., London, Onatrio, Canada N6A 4V2.
authors.initials: GA
authors.lastname: Vilos
authors.initials: JT
authors.lastname: Pispidikis
authors.initials: CK
authors.lastname: Botz