Costs and health-related quality of life effects of hysterectomy in patients with benign uterine disorders.
OBJECTIVE
To gain knowledge about the utility of hysterectomy in a real-world setting and to relate the utility of the intervention to its costs.


METHODS
Prospective observational study.


METHODS
University referral hospital in Helsinki.


METHODS
A total of 337 women entering for routine hysterectomy due to a benign disease (210 benign uterine or ovarian cause, 20 endometriosis, 51 uterovaginal prolapse, 56 menorrhagia).


METHODS
Patients filled in the 15D health-related quality of life (HRQoL) questionnaire before and six months after the operation. Costs were examined from the perspective of secondary care provider. Benefits of surgery were extrapolated till the end of remaining statistical life expectancy of each woman in the prolapse group and until menopause in the other groups.


METHODS
HRQoL and cost per quality-adjusted life year (QALY) gained.


RESULTS
Mean [standard deviation (SD)] HRQoL score (on a 0-1 scale) in the whole group improved from the preoperative of 0.905 (0.073) to 0.925 (0.077) six months after the operation (p < 0.001). The largest mean (SD) improvement was seen in patients with endometriosis [0.048 (0.067)] followed by those with menorrhagia [0.024 (0.054)], benign uterine or ovarian cause [0.018 (0.071)], and prolapse [0.017 (0.055)]. In the whole group, the intervention produced a mean (SD) of 0.222 (1.270) QALYs at mean (SD) direct hospital cost of euro3,138 (2,098). Consequently, the cost per QALY gained in the whole group was euro14,135 varying from euro3,720 to 31,570 in the disease groups.


CONCLUSIONS
The cost per QALY gained for hysterectomy for benign uterine disorders is strongly dependent on the indication for surgery.
Taipale
Kaisa
K
Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
Leminen
Arto
A
Räsänen
Pirjo
P
Heikkilä
Anne
A
Tapper
Anna-Maija
AM
Sintonen
Harri
H
Roine
Risto P
RP
D000328:Adult; D000367:Age Factors; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D014591:Uterine Diseases / Q000191:economics / Q000601:surgery*