title: An economic evaluation of outpatient versus inpatient polyp treatment for abnormal uterine bleeding.
abstract: OBJECTIVE
  To undertake a cost-effectiveness analysis of outpatient uterine polypectomy compared with standard inpatient treatment under general anaesthesia.
  
  
  METHODS
  Economic evaluation carried out alongside the multi-centre, pragmatic, non-inferiority, randomised controlled Outpatient Polyp Treatment (OPT) trial. The UK National Health Service (NHS) perspective was used in the estimation of costs and the interpretation of results.
  
  
  METHODS
  Thirty-one secondary care UK NHS hospitals between April 2008 and July 2011.
  
  
  METHODS
  Five hundred and seven women with abnormal uterine bleeding and hysteroscopically diagnosed endometrial polyps.
  
  
  METHODS
  Outpatient uterine polypectomy versus standard inpatient treatment. Clinicians were free to choose the technique for polypectomy within the allocated setting.
  
  
  METHODS
  Patient-reported effectiveness of the procedure determined by the women's self-assessment of bleeding at 6 months, and QALY gains at 6 and 12 months.
  
  
  RESULTS
  Inpatient treatment was slightly more effective but more expensive than outpatient treatment, resulting in relatively high incremental cost-effectiveness ratios. Intention-to-treat analysis of the base case at 6 months revealed that it cost an additional £9421 per successfully treated patient in the inpatient group and £ 1,099,167 per additional QALY gained, when compared with outpatient treatment. At 12 months, these costs were £22,293 per additional effectively treated patient and £445,867 per additional QALY gained, respectively.
  
  
  CONCLUSIONS
  Outpatient treatment of uterine polyps associated with abnormal uterine bleeding appears to be more cost-effective than inpatient treatment at willingness-to-pay thresholds acceptable to the NHS.
  
  
  CONCLUSIONS
  HTA-funded OPT trial concluded that outpatient uterine polypectomy is cost-effective compared with inpatient polypectomy.
authors.affiliation: Health Economics Unit, School of Health and Population Science, University of Birmingham, Birmingham, UK.
authors.forename: L
authors.initials: L
authors.lastname: Diwakar
authors.affiliation: Health Economics Unit, School of Health and Population Science, University of Birmingham, Birmingham, UK.
authors.forename: T E
authors.initials: TE
authors.lastname: Roberts
authors.affiliation: Women's Health Research Unit, Queen Mary University of London, London, UK.
authors.forename: N A M
authors.initials: NA
authors.lastname: Cooper
authors.affiliation: Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK.
authors.forename: L
authors.initials: L
authors.lastname: Middleton
authors.affiliation: Health Economics Unit, School of Health and Population Science, University of Birmingham, Birmingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Jowett
authors.affiliation: Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Daniels
authors.affiliation: Birmingham Women's NHS Foundation Trust, Birmingham, UK.
authors.forename: P
authors.initials: P
authors.lastname: Smith
authors.affiliation: Birmingham Women's NHS Foundation Trust, Birmingham, UK.|School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK.|University of Birmingham, Birmingham, UK.
authors.forename: T J
authors.initials: TJ
authors.lastname: Clark
mesh_terms: D000553:Ambulatory Care / Q000191:economics* / Q000706:statistics & numerical data; D057186:Comparative Effectiveness Research; D003365:Costs and Cost Analysis; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000191:economics*; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D010045:Outpatients; D057240:Patient Preference; D011127:Polyps / Q000150:complications / Q000191:economics* / Q000601:surgery; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D014592:Uterine Hemorrhage / Q000191:economics* / Q000209:etiology / Q000601:surgery
keywords: Cost-effectiveness; Outpatient Polyp Treatment trial; endometrial polyps; hysteroscopy; inpatient; outpatient