A COST COMPARISON OF HYSTERECTOMY AND HYSTEROSCOPIC SURGERY FOR THE TREATMENT OF MENORRHAGIA

Objectives: To estimate and compare the costs of treating women with m enorrhagia by hysterectomy or hysteroscopic surgery, in the form of tr anscervical resection of the endometrium (TCRE) or endometrial laser a blation (ELA). Study design: Randomised controlled trial set in the gy naecological department of a large British teaching hospital. Under us ual circumstances, 204 women who would have undergone hysterectomy for menorrhagia were randomly allocated to either hysterectomy (n = 99) o r hysteroscopic surgery in the form of TCRE (n = 52) or ELA (n = 53). National Health Service (NHS) costs and costs to patients per patient occurring up to 1 year following surgery were estimated. Theatre times and length of hospital stay were recorded during the trial. Costs wer e obtained from the health board finance department and relevant suppl iers of technical equipment. One year after treatment patients complet ed questionnaires on personal costs incurred. Results: The NHS costs o f treating women with hysteroscopic surgery were 24% (TCRE) or 20% (EL A) less than treating women by hysterectomy (pound 1001/pound 1046 vs. pound 1315). On average, women undergoing hysteroscopic surgery incur red 71% less costs to themselves than those who underwent hysterectomy (pound 21 vs. pound 73.40). Conclusions: Hysteroscopic endometrial ab lation incurs less costs than hysterectomy both to the National Health Service and to women alike, up to 1 year after surgery.