USE OF GNRH AGONIST BEFORE HYSTERECTOMY - A COST SIMULATION

Objective: To evaluate the potential savings in cost of care derived f rom performing vaginal hysterectomies instead of abdominal hysterectom ies in selected women with fibroid uteri equivalent in size to a 14-18 week gestation. Methods: Women 35-46 years of age undergoing hysterec tomy for fibroid uteri were selected to allow application of conversio n rates gained in a separate randomized study using leuprolide acetate depot 3.75 mg. Statewide public data for North Carolina's hospital di scharges provided relative rates of hospital charges and leiomyomas fo r all hysterectomies, by age. Professional charges were omitted from t he analysis. Estimated savings were projected to the national level. R esults: During 1992 in North Carolina, 18,110 inpatient hysterectomies were performed for women of all ages; 28.1% of these were for uterine leiomyomas. For women 35-46 years old (12.7% of all hysterectomies), there were 1904 abdominal and 390 vaginal hysterectomies; the mean tot al charge for abdominal hysterectomy was $5590, and $4732 for the vagi nal alternative. These statewide data provide missing elements to allo w a national estimate of the potential savings of using GnRH agonist p reoperatively. The projected national savings, if 1987 utilization dat a are used, was $4.6 million, nearly 1.4% of the inpatient charges. Th e 1992 value of these savings is $6.7 million. Conclusion: The use of preoperative GnRH agonist therapy before hysterectomy for patients wit h a uterine size equivalent to a 14-18 week gestation represents a sig nificant cost-saving alternative, increasing the use of vaginal hyster ectomy and resulting in potential savings in direct inpatient medical care charges.