RANDOMIZED TRIAL COMPARING HYSTERECTOMY AND TRANSCERVICAL ENDOMETRIALRESECTION - EFFECT ON HEALTH-RELATED QUALITY-OF-LIFE AND COSTS 2 YEARS AFTER SURGERY

Objective To compare the impact of endometrial resection and abdominal hysterectomy on a range of health outcomes and health service costs, based on longer term follow up of patients randomised to a clinical tr ial. Design A parallel group randomised control trial. Setting The gyn aecology department of a teaching hospital. Participants 196 women req uiring surgical treatment for menorrhagia were randomised and received surgery (88 underwent resection and 97 hysterectomy). Longer term fol low up was undertaken using a postal questionnaire sent to all 196 wom en. Main outcome measures Longer term assessment was on the basis of m enstrual symptoms, health related quality of life using the Short Form 36 (SF36) and the EuroQol(C) visual analogue scale, patient satisfact ion and health service resource cost. Results Of 196 women who were se nt a questionnaire, 155 (79 %)responded at an average interval of 2.8 years after initial surgery. All aspects of health outcomes were as go od or better in patients randomised to hysterectomy. Among patients ra ndomised to resection, 57% had experienced no improvement in premenstr ual symptoms following surgery and 23 % had taken time off work due to menstrual problems; among hysterectomy patients, these rates were 23 % and 4%, respectively. Women randomised to hysterectomy had better me an scores on seven of the eight dimensions of the SF36 health related quality of life instrument, with the greatest difference being on the pain dimension (P = 0.01). Women randomised to hysterectomy were gener ally more satisfied with treatment (P = 0.002). By two years after ini tial surgery, women randomised to resection had a 12% probability of h aving had a repeat resection and a 16% chance of having had a hysterec tomy. As a percentage of the mean total cost associated with women ran domised to hysterectomy, the mean total cost of resection was 53% base d on four months follow up; this proportion had increased to 71%, base d on an average overall follow up of 2.2 years. Conclusions These resu lts show that, at an average follow up of 2.8 years among responders t o a questionnaire, women randomised to hysterectomy experienced more o f an improvement in menstrual symptoms and higher rates of satisfactio n with treatment. There is also some evidence of superior health relat ed quality of life amongst hysterectomy patients. However, the health service cost of endometrial resection remains lower than that of hyste rectomy. An assessment of the relative cost effectiveness of the two p rocedures awaits further research.