title: Cost effectiveness of laparoscopy versus laparotomy in early stage endometrial cancer: a randomised trial.
abstract: OBJECTIVE
  To determine the cost effectiveness of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) in early stage endometrial cancer alongside a multicenter randomised controlled trial (RCT).
  
  
  METHODS
  An economic analysis was conducted in 279 patients (TLH n=185; TAH n=94) with early stage endometrial cancer from a societal perspective, including all relevant costs over a three month time horizon. Health outcomes were expressed in terms of major complication-free rate and in terms of utility based on women's response to the EQ-5D. Comparisons of costs per major complication-free patient gained and costs with utility gain and costs were made, using incremental cost effectiveness ratios.
  
  
  RESULTS
  The mean major complication-free rate and median utility scores were comparable between TLH and TAH at three months. TLH is more costly intraoperatively (Δ$1.129) and less costly postoperatively in-hospital (Δ$-1.350) compared to TAH. Incremental costs per major complication-free patient were $-52. Higher cost ($249) were generated while no gains in utility (-0.02) were observed for TLH compared to TAH. Analysing utility at six weeks, incremental costs per additional point on the EQ-5D scale were $1.617.
  
  
  CONCLUSIONS
  TLH is cost effective compared to TAH, based on major complication-free rate as measure of effect. Along with future cost saving strategies in laparoscopy, TLH is assumed to be cost effective for both effect measures. Therefore and due to comparable safety, TLH should be recommended as a standard-of-care surgical procedure in early endometrial cancer.
authors.affiliation: Department of Gynaecology, University Medical Center Groningen, The Netherlands.
authors.forename: Claudia B
authors.initials: CB
authors.lastname: Bijen
authors.forename: Karin M
authors.initials: KM
authors.lastname: Vermeulen
authors.forename: Marian J
authors.initials: MJ
authors.lastname: Mourits
authors.forename: Henriëtte J
authors.initials: HJ
authors.lastname: Arts
authors.forename: Henk G
authors.initials: HG
authors.lastname: Ter Brugge
authors.forename: Rob
authors.initials: R
authors.lastname: van der Sijde
authors.forename: Jacobus
authors.initials: J
authors.lastname: Wijma
authors.forename: Marlies Y
authors.initials: MY
authors.lastname: Bongers
authors.forename: Ate G
authors.initials: AG
authors.lastname: van der Zee
authors.forename: Geertruida H
authors.initials: GH
authors.lastname: de Bock
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000191:economics* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D016889:Endometrial Neoplasms / Q000191:economics* / Q000601:surgery*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007044:Hysterectomy / Q000191:economics* / Q000379:methods*; D010535:Laparoscopy / Q000191:economics / Q000379:methods; D007813:Laparotomy / Q000191:economics / Q000379:methods; D008875:Middle Aged; D009426:Netherlands; D016896:Treatment Outcome