Open AccessCost‐effectiveness of hysterectomy for benign gynecological conditions: a systematic review
Author(s) -
Pynnä Kristiina,
Vuorela Piia,
Lodenius Leena,
Paavonen Jorma,
Roine Risto P.,
Räsänen Pirjo
Publication year - 2014
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12299
Subject(s) - medicine , hysterectomy , cinahl , psycinfo , medline , cochrane library , cost effectiveness , quality of life (healthcare) , systematic review , economic evaluation , surgery , psychological intervention , randomized controlled trial , nursing , risk analysis (engineering) , pathology , political science , law
The objective of this study was to assess the cost‐effectiveness of hysterectomy performed for benign indications. Hysterectomy remains the most common major gynecological operation in the Western world. Rates of hysterectomy have not declined as expected with the introduction of new treatment options. Furthermore, use of laparoscopic techniques varies widely within the Nordic countries. We designed a systematic review in a University Central Hospital. The sample included all published studies regarding the cost‐effectiveness of hysterectomy performed for benign indications ( n = 1666). Medline, Cochrane Library, PsycINFO, CINAHL, and Nursing databases were searched. Inclusion criteria were the availability of pre‐ and post‐intervention health‐related quality of life measures ( HRQ oL) and data on costs. HRQ oL, costs, and cost‐effectiveness of treatment were the main outcome measures. Studies ( n = 24) focused on treatment of symptomatic fibroids ( n = 8), treatment of heavy menstrual bleeding ( n = 10), various surgical techniques ( n = 5) and the effect of various indications for hysterectomy ( n = 2). Follow‐up periods varied from 4 months to over 10 years. SF / RAND ‐36 or EQ ‐5D measures and societal cost perspective were most commonly used. Only 11 studies used individual patient data. HRQ oL following hysterectomy was generally good but costs were high. The cost‐effectiveness depended on indication, age, and duration of follow‐up. The cost‐effectiveness of hysterectomy has been surprisingly poorly studied. Conclusions are difficult to draw due to different study designs, indications, follow‐up times, and HRQ oL instruments used. Rates of hysterectomy have declined less than expected with the introduction of new treatment modalities. Costs of surgery are high. Laparoscopic hysterectomy seems to be the least cost‐effective, although further data from original patient cohorts with long‐term follow‐up are needed.