A RANDOMIZED TRIAL WITH A COST-CONSEQUENCE ANALYSIS AFTER LAPAROSCOPIC AND ABDOMINAL HYSTERECTOMY

Objective: To perform a cost-consequence analysis after total laparosc opic hysterectomy (TLH) and total abdominal hysterectomy (TAH). Method s: Women scheduled for TAH were randomized prospectively to undergo th e procedure by laparoscopic (n = 71) or abdominal (n = 72) surgery. Po stoperative health status was assessed using The Medical Outcome Trust 36-Item Short-Form Health Survey questionnaire. The financial account ing system at the hospital and information from the local national hea lth insurance office were used for the economic analysis. We evaluated changes in direct costs (hospital costs) and indirect costs (loss of production value) when performing a laparoscopic hysterectomy instead of an abdominal hysterectomy. Results: Postoperative health status imp roved significantly faster after TLH than after TAH. The direct costs were 1.7% higher and the indirect costs 50.3% lower for patients under going laparoscopic surgery. The total costs were 23.1% lower after lap aroscopic hysterectomy. Conclusion: A change in surgical technique fro m abdominal to laparoscopic hysterectomy was possible without compromi sing the health status of the patients, and it provided substantial fi nancial benefits to society. (C) 1998 by The American College of Obste tricians and Gynecologists.