A COST-ANALYSIS OF ENDOMETRIAL ABLATION, ABDOMINAL HYSTERECTOMY, VAGINAL HYSTERECTOMY, AND LAPAROSCOPIC-ASSISTED VAGINAL HYSTERECTOMY IN THE TREATMENT OF PRIMARY MENORRHAGIA

Study Objective. To assess the cost of lour procedures performed to tr eat primary menorrhagia. Design. Retrospective analysis. Setting. A 39 4-bed womens' teaching hospital. Patients. Eighty healthy women underg oing one oi the lour procedures. interventions. The study patients wer e equally divided among vaginal hysterectomy (VH), total abdominal hys terectomy (TAH), laparoscopic-assisted vaginal hysterectomy (LAVH), an d endometrial ablation (EA). Measurements and Main Results. Endometria l ablation was associated with significantly reduced hospital costs an d a shorter recovery period than the other modalities. Hospital costs were less for VH and return to work was quicker after LAVH and VH. Thi s study did not evaluate long-term failures or complications unless th ey occurred within the first 2 months after the procedure. Conclusion. Among women who could be treated by any of these techniques, VH was s ignificantly more cost effective for the permanent management of prima ry menorrhagia than LAVH and TAH. The cost efficiency of EA was clearl y implied, but further studies must be completed to evaluate the long- term costs associated with treatment failures. Although physicians sho uld not choose a procedure based exclusively on cost, the expense of a less efficient or more costly procedure may affect a hospital's compe titiveness in this era of managed care.