Economic evaluation of three surgical interventions for menorrhagia

BACKGROUND: The study was carried out to compare the overall effectiveness and direct economic costs of vaginal hysterectomy (VH), endometrial ablation (EA) and thermo-coagulation (TC) for the treatment menorrhagia. METHODS: We treated 50, 50 and 47 women with menorrhagia (>150 points on the Higham pictorial chart) by VH, EA and TC respectively. The patients were treated consecutively by the same surgeon and the choice between the three procedures depended on the desire of the patients. Resource utilization for the interventions was collected retrospectively from the hospital charts. A study questionnaire was mailed to the patients 24-36 months after the primary surgery. Patients who reported that they had undergone a second procedure or who were still menorrhagic were considered as treatment failures. RESULTS: As expected, the failure rate was lowest for VH. The total cost (without re-intervention for persistent menorrhagia) was e5315 for VH, e1098 for EA and e921 for TC. The total cost with re-intervention was calculated based on therapeutic strategies used in 2001 and estimated at e5321 for VH, e1263 for EA and e1320 for TC. CONCLUSIONS: The two out-patient procedures are very comparable in terms of success rates and costs. Choices will depend on budgeting considerations, surgeon skill and patient preference. The results may give guidance to investment decisions.