COSTS OF HYSTERECTOMY - DOES SURGICAL APPROACH MAKE A DIFFERENCE

We wanted to determine the direct cost of hysterectomies by surgical a pproach and to estimate the impact on costs if more vaginal hysterecto mies were substituted for abdominal hysterectomies for women under 50 years of age. Eleven Ontario (Canada) hospitals provided 1994 cost dat a based on 1376 hysterectomies. These data were applied to all hystere ctomies performed in the province for women under 50 to estimate the c ost of subtotal, vaginal (VH), or laparoscopically assisted vaginal hy sterectomy (LAVH) relative to total abdominal hysterectomy (TAH). We d etermined the change in costs if TAHs in Ontario in 1994-1995 had been substituted by VH or LAVH. Teaching and community hospitals were cons idered separately. VH was less costly than TAH, subtotal, or LAVH. The direct cost for TAH at teaching hospitals was much higher than at com munity hospitals. Costs relative to TAH were higher for LAVH at commun ity but not at teaching hospitals. From the population baseline rate o f 25% VH, 5% LAVH, 10% subtotal, and 60% TAH, we estimated that increa sing VH to 45% would lower costs by 2.4%; increasing LAVH to 25% would increase costs by 4.4%. VH is associated with lower costs than TAH or LAVH. However, the magnitude of the substitution and the extent of co st savings should ultimately be based on evaluation of patient outcome s.