背景:作为女性常见的盆腔肿瘤,在中国,子宫肌瘤仍然是子宫切除术的主要原因。子宫切除术为子宫肌瘤提供了良好的手术治疗,它保证了所有子宫肌瘤的切除,而不会降低复发的风险。这项研究从社会角度比较了全腹腔镜子宫切除术(TLH)与全开腹子宫切除术(TAH)对子宫肌瘤女性的成本效益。
方法:对392例患者(TLHn=75;TAHn=317)进行了经济学分析。包括12个月时间范围内的所有相关成本。主要结果是主要的手术并发症;次要结果是术后不适症状和恢复正常活动的时间。临床,结果和费用数据是从医疗记录中收集的,电话调查和财务信息系统。使用广义线性模型来评估两组之间的成本和结果差异。增量成本效益比(ICER)用于估计成本效益。
结果:TLH的平均直接成本为2,925.71美元,TAH为2,436.24美元,分别。TLH的平均间接成本为1,133.22美元,TAH$1,394.85,分别。社会成本增量为256.86美元(95CI:249.03-264.69)。结果的平均差异为:主要手术并发症为4.53%(95CI:4.35-4.71);术后不适症状为6.75%(95CI:6.45-7.05);恢复到正常活动的时间为1.27(95CI:1.23-1.30)周。TLH的ICER为$5,669.16(95CI:5,384.76-5,955.56)每个并发症避免,每次避免术后不适症状为$3,801.54(95CI:3,634.81-3,968.28),每周节省$202.96(95CI:194.97-210.95)以恢复正常活动。
结论:根据我们估计的中国保守阈值,与TAH相比,TLH在预防其他并发症方面具有成本效益。这些发现为研究人员在前瞻性研究的基础上进行进一步的成本效益分析提供了有用的信息,可以提供更强有力的证据,在中国。此外,这些数据可能有助于中国医疗政策制定者和医疗保险支付者做出相关的医疗决策.
BACKGROUND: As a common female pelvic tumor, uterine fibroids remain the leading cause for hysterectomy in China. Hysterectomy provides a good surgical treatment of uterine fibroids, and it guarantees the removal of all uterine fibroids without lower risk of recurrence. This study compares the cost effectiveness of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) for women with uterine fibroids from a societal perspective.
METHODS: An economic analysis was conducted in 392 patients (TLH n = 75; TAH n = 317), including all relevant costs over a 12-month time horizon. Primary outcome was major surgical complications; secondary outcomes were postoperative discomfort symptoms and time of return to normal activities. Clinical, outcomes and costs data were collected from medical records, telephone survey and financial information system. Generalized linear models were used to assess costs and outcomes differences between the two groups. Incremental cost effectiveness ratio (ICER) was used to estimate the cost effectiveness.
RESULTS: Mean direct costs were $2,925.71 for TLH, $2,436.24 for TAH, respectively. Mean indirect costs were $1,133.22 for TLH, $1,394.85 for TAH, respectively. Incremental societal costs were $256.86 (95%CI: 249.03-264.69). Mean differences in outcome were: 4.53% (95%CI: 4.35-4.71) for major surgical complications; 6.75% (95%CI: 6.45-7.05) for postoperative discomfort symptoms; 1.27 (95%CI: 1.23-1.30) weeks for time to return to normal activities. ICER of TLH was $5,669.16 (95%CI: 5,384.76-5,955.56) per complication averted, $3,801.54 (95%CI: 3,634.81-3,968.28) per postoperative discomfort symptoms averted and $202.96 (95%CI: 194.97-210.95) per week saved to return to normal activities.
CONCLUSIONS: TLH is cost effective compared with TAH in preventing additional complications based on our estimated conservative threshold in China. The findings provide useful information for researchers to conduct further cost effectiveness analysis based on prospective study which can provide stronger and more evidence, in China. In addition, the data may be useful for Chinese health care policy-makers and medical insurance payers to make related health care decisions.