Cost effectiveness analysis of laparoscopic hysterectomy compared with standard hysterectomy: results from a randomised trial

摘要

Objective: To assess the cost effectiveness of laparoscopic hysterectomy compared with conventional hysterectomy (abdominal or vaginal). Design: Cost effectiveness analysis based on two parallel trials: laparoscopic (n = 324) compared with vaginal hysterectomy (n = 163); and laparoscopic (n = 573) compared with abdominal hysterectomy (n = 286). Participants: 1346 women requiring a hysterectomy for reasons other than malignancy. Main outcome measure: One year costs estimated from NHS perspective. Health outcomes expressed in terms of QALYs based on women's responses to the EQ-5D at baseline and at three points during up to 52 weeks' follow up. Results: Laparoscopic hysterectomy cost an average of pound401 ($708; C571) more (95% confidence interval pound271 to pound542) than vaginal hysterectomy but produced little difference in mean QALYs (0.0015, 0.0 15 to 0.0 18). Mean differences in cost and QALYs generated an incremental cost per QALY gained of pound267 333 ($471789; E380 437). The, probability that laparoscopic hysterectomy is cost effective was below 50% for a large range of values of willingness to pay for an additional QALY. Laparoscopic hysterectomy cost an average of pound186 ($328; E265) more than abdominal hysterectomy, although 95% confidence intervals crossed zero -pound26 to pound375); there was little difference in mean QALYs (0.007, - 0.008 to 0,023), resulting in an incremental cost per QALY gained of pound26 571 ($46 893; E37 813). If the NHS is willing to pay pound30 0 00 for an additional QALY, the probability that laparoscopic hysterectomy is cost effective is 56%. Conclusions: Laparoscopic hysterectomy is not cost effective relative to vaginal hysterectomy. Its cost effectiveness relative to the abdominal procedure is finely balanced.