Economic evaluation of three surgical interventions for menorrhagia.
BACKGROUND
The study was carried out to compare the overall effectiveness and direct economic costs of vaginal hysterectomy (VH), endometrial ablation (EA) and thermo-coagulation (TC) for the treatment menorrhagia.


METHODS
We treated 50, 50 and 47 women with menorrhagia (>150 points on the Higham pictorial chart) by VH, EA and TC respectively. The patients were treated consecutively by the same surgeon and the choice between the three procedures depended on the desire of the patients. Resource utilization for the interventions was collected retrospectively from the hospital charts. A study questionnaire was mailed to the patients 24-36 months after the primary surgery. Patients who reported that they had undergone a second procedure or who were still menorrhagic were considered as treatment failures.


RESULTS
As expected, the failure rate was lowest for VH. The total cost (without re-intervention for persistent menorrhagia) was 5315 Euros for VH, 1098 Euros for EA and 921 Euros for TC. The total cost with re-intervention was calculated based on therapeutic strategies used in 2001 and estimated at 5321 Euros for VH, 1263 Euros for EA and 1320 Euros for TC.


CONCLUSIONS
The two out-patient procedures are very comparable in terms of success rates and costs. Choices will depend on budgeting considerations, surgeon skill and patient preference. The results may give guidance to investment decisions.
Fernandez
Hervé
H
Service de Gynécologie-Obstétrique, Université Paris-Sud, Hôpital Antoine Béclère (AP-HP), 157 Rue de la Porte de Trivaux, 92141 Clamart Cedex, France. herve.fernandez@abc.ap-hop-paris.fr
Kobelt
Giséla
G
Gervaise
Amélie
A
D000328:Adult; D004564:Electrocoagulation / Q000191:economics; D004717:Endometrium / Q000601:surgery; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000191:economics; D015907:Hysteroscopy / Q000191:economics; D008595:Menorrhagia / Q000601:surgery*; D008875:Middle Aged; D012086:Reoperation / Q000191:economics; D016896:Treatment Outcome