What is the cost effectiveness of laparoscopic hysterectomy compared with conventional (vaginal or abdominal) hysterectomy?
Two parallel multicentre randomised controlled trials.
Main results Vaginal hysterectomy:
Laparoscopic hysterectomy was significantly more expensive than vaginal hysterectomy, however there were no differences in quality adjusted life years (QALYs; see Table 1).
There were no significant differences between abdominal and laparoscopic hysterectomy for cost or QALYs. For each additional QALY, laparoscopic hysterectomy was estimated to cost £267,333 more than vaginal hysterectomy, and £26,571 more than abdominal hysterectomy.
|Table 1 Relative cost and effectiveness of laparoscopic versus conventional hysterectomy techniques (£ sterling at 1999/2000 rates). |
|Comparison ||Mean difference in cost (95% CI) ||Mean difference in QALYs (95% CI) ||ICER |
|Laparoscopic vs vaginal ||£401 (271 to 542) ||0.0015(–0.0015 to 0.018) ||£267,333 |
|Laparoscopic vs abdominal ||£186 (–26 to +375) ||0.007(–0.008 to 0.023) ||£26,571 |
QALY, quality adjusted life year; ICER, incremental cost effectiveness ratio (mean difference in cost divided by mean difference in QALYs)
Laparoscopic hysterectomy does not offer any cost-effectiveness benefit over vaginal hysterectomy. Laparoscopic hysterectomy was similarly cost effective to abdominal hysterectomy.
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Keywords : Hysterectomy, Laparoscopy, Quality of life, Cost-benefit analysis, Hospital costs, Randomised controlled trial
| Abstracted from: Sculpher M, Manca A, Abbott J et al. Cost effectiveness analysis of laparoscopic hysterectomy compared with standard hysterectomy: results from a randomised trial. BMJ 2004; 328: 134–137.
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