Long-term economic evaluation of resectoscopic endometrial ablation versus hysterectomy for the treatment of menorrhagia

Abstract

Study objective: To assess long-term costs of resectoscopic endometrial ablation versus hysterectomy in women with menorrhagia.

Design: Controlled cohort study (Canadian Task Force classification II-2).

Setting: Multispeciality group practice.

Patients: Sixty-four women who underwent endometrial ablation during 1992-1994 and 46 women who underwent hysterectomy during 1990-1992. To attain comparable controls, patients with uterine size exceeding 14 weeks or uterine weight greater than 300 g, ovarian pathology, endometriosis, or neoplasia were excluded.

Interventions: Endometrial ablation and hysterectomy, followed by economic evaluation.

Measurements and main results: Direct costs were hospitalization charges, professional fees, preoperative depot leuprolide, and gynecologic care during 3 years after primary surgery. Indirect costs were calculated based on known demographic data, recovery time, and lost productivity. Surgical outcomes, complications, repeat surgeries, menstrual outcomes, and overall patient satisfaction were assessed. Operating time (38 vs 107 min), hospital stay (0.7 vs 2.7 days), frequency of postoperative complications (6.3% vs 21.7%), and recuperation time (5 vs 32 days) were less with endometrial ablation than with hysterectomy. Mean follow-up was 48.5 months (range 36-68 mo), with rates of amenorrhea, hypomenorrhea, and eumenorrhea of 49%, 29%, and 8%, respectively. One patient was lost to follow-up. There were eight failures (12%): repeat endometrial ablations (2 women), abdominal hysterectomy (1), and laparoscopic-assisted hysterectomy (5). Most women (85%) remained satisfied with the operation. Total direct costs/case for endometrial ablation were $5434 versus $8417 for hysterectomy; respective indirect costs/case were $525 and $3360. Conclusion. Long-term direct and indirect costs of endometrial ablation were significantly less than those of hysterectomy ($5959 vs $11,777) for the treatment of menorrhagia.