Peripartum hysterectomy: an economic analysis of direct healthcare costs using routinely collected data

ObjectiveTo estimate resource use and costs associated with peripartum hysterectomy for the English National Health Service. Design/SettingAnalysis of linked Clinical Practice Research Datalink and Hospital Episodes Statistics (CPRD-HES) data. PopulationWomen undergoing peripartum hysterectomy between 1997 and 2013 and matched controls. MethodsInverse probability weighted generalised estimating equations were used to model the non-linear trend in healthcare service use and costs over time, accounting for missing data, adjusting for maternal age, body mass index, delivery year, smoking and socio-economic indicators. Main outcome measuresPrimary care, hospital outpatient and inpatient attendances and costs (UK 2015 prices). ResultsThe study sample included 1362 women (192 cases and 1170 controls) who gave birth between 1997 and 2013; 1088 (153 cases and 935 controls) of these were deliveries between 2003 and 2013 when all categories of hospital resource use were available. Based on the 2003-2013 delivery cohort, peripartum hysterectomy was associated with a mean adjusted additional total cost of 5380 (95% CI 4436-6687) and a cost ratio of 1.76 (95% CI 1.61-1.98) over 5 years of follow up compared with controls. Inpatient costs, mostly incurred during the first year following surgery, accounted for 78% excluding or 92% including delivery-related costs. ConclusionPeripartum hysterectomy is associated with increased healthcare costs driven largely by increased post-surgery hospitalisation rates. To reduce healthcare costs and improve outcomes for women who undergo hysterectomy, interventions that reduce avoidable repeat hospitalisations following surgery such as providing active follow up, treatment and support in the community should be considered.