LAPAROSCOPIC AND ABDOMINAL HYSTERECTOMY - A COST COMPARISON

Objective: To compare the cost of laparoscopically assisted vaginal hy sterectomy (LAVH) with that of total abdominal hysterectomy (TAH) unde r casemix. Design: Retrospective comparison of the costs, operating ti me and length of hospital stay. Patients: The 16 women undergoing cons ecutive LAVH and 16 age-matched women undergoing TAH between 1 Februar y 1994 and 31 July 1995; all women were public patients undergoing hys terectomy for benign disease. Setting: Monash Medical Centre, a large tertiary teaching hospital in Melbourne, Australia, where casemix is u sed to determine funding and budget allocation. Results: The differenc e between the costs of the two procedures was not statistically signif icant (P=0.5), despite the cost of laparoscopic hysterectomy including that of disposables. The mean operating time for TAH was 86 minutes ( 95% CI, 65.5-106.5), compared with 120 minutes (95% CI, 100.8-140.5) f or LAVH (P<0.01). The mean length of stay in the TAH group was 5.75 da ys, compared with 3.25 days in the LAVH group (P<0.001). Conclusion: I n hysterectomy for benign gynaecological disease, the laparoscopic pro cedure costs the same as the total abdominal procedure. Audit such as this is important in patient management and in guiding hospitals in fu nding and bed allocation.