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A Cost-Utility Analysis of Abdominal Hysterectomy Versus Transcervical Endometrial Resection for the Surgical Treatment of Menorrhagia

Published online by Cambridge University Press:  10 March 2009

Mark Sculpher
Mark Sculpher
Affiliation:
Brunei University
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Abstract

Menorrhagia, or heavy regular menstrual bleeding, represents a major health burden to women. Trials comparing abdominal hysterectomy (AH) with transcervical resection of the endometrium (TCRE) for the condition have shown that, although the duration and severity of convalescence is less with TCRE, AH produces a permanent solution to heavy bleeding while TCRE fails in a proportion of women by 2 years. However, by 2 years, TCRE costs only 71% that of AH. This paper presents a cost-utility analysis to assess which procedure is more cost-effective overall. Under most plausible parameter values and on the basis of health state values elicited from a sample of women with menorrhagia, AH is likely to be considered more cost-effective than TCRE if purchasers are willing to pay an additional cost of at least £6,500 per extra quality-adjusted life-year generated by AH.

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 14 , Issue 2 , Spring 1998 , pp. 302 - 319
Copyright
Copyright © Cambridge University Press 1998

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References

REFERENCES

1.Bradlow, J., Coulter, A., & Brooks, P.Patterns of referral, Oxford. Oxford: Health Services Research Unit, 1992.Google Scholar
2.Bridgman, S. A.Increasing operative rates for dysfunctional uterine bleeding after endometrial ablation [letter]. Lancet, 1994, 344, 893.CrossRefGoogle ScholarPubMed
3.Briggs, A., Sculpher, M. J., & Buxton, M.Uncertainty in the economic evaluation of health care technologies: The role of sensitivity analysis. Health Economics, 1994, 3, 95–104.CrossRefGoogle ScholarPubMed
4.Brooks, R.EuroQol: The current state of play. Health Policy, 1996, 37, 53–72.CrossRefGoogle ScholarPubMed
5.Brown, J., & Sculpher, M. J.Economics of screening programs to prevent cervical cancer. Contemporary Reviews in Obstetrics and Gynecology, 1993, 5, 221–229.Google Scholar
6.Chartered Institute of Public Finance and Accountancy (CIPFA). Health service trends, vol. 2—Detailed tables. London: Health Care Financial Management Association, 1990.Google Scholar
7.Clarke, A., Black, N., Rowe, P., et al. Indications for and outcome of total abdominal hysterectomy for benign disease: A prospective cohort study. British Journal of Obstetrics and Gynecology, 1995, 102, 611–20.CrossRefGoogle ScholarPubMed
8.Coulter, A., Kelland, J., Peto, V., et al. Treating menorrhagia in primary care: An overview of drug trials and a survery of prescribing practice. International Journal of Technology Assessment in Health Care, 1995, 11, 456–71.CrossRefGoogle Scholar
9.Coulter, A., Peto, V., & Doll, H.Patients' preferences and general practitioners' decisions in the treatment of menstrual disorders. Family Practice, 1994, 11, 67–74.CrossRefGoogle ScholarPubMed
10.Coulter, A., Peto, V., & Jenkinson, C.Quality of life and patient satisfaction following treatment for menorrhagia. Family Practice, 1994, 11, 394–401.CrossRefGoogle ScholarPubMed
11.Daly, E., Gray, A., Barlow, D., et al. Measuring the impact of menopausal symptoms on quality of life. British Medical Journal, 1993, 307, 836–40.CrossRefGoogle ScholarPubMed
12.Dicker, R. C., Greenspan, J. R., Strauss, L. T., et al. Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. American Journal of Obstetrics and Gynecology, 1982, 144, 841–48.CrossRefGoogle ScholarPubMed
13.Drummond, M. F., Brandt, A., Luce, B., et al. Standardizing methodologies for economic evaluation in health care. Internationa/Journal of Technology Assessment in Health Care, 1993, 9, 26–36.CrossRefGoogle ScholarPubMed
14.Drummond, M. F., Mason, J., Torrance, G.Cost-effectiveness league tables: Think of the fans. Health Policy, 1995, 31, 231–38.CrossRefGoogle ScholarPubMed
15.Dwyer, N., Hutton, J., & Stirrat, G. M.Randomized controlled trial comparing endometrial resection with abdominal hysterectomy for the surgical treatment of menorrhagia. British Journal of Obstetrics and Gynecology, 1993, 100, 237–43.CrossRefGoogle ScholarPubMed
16.Effective Health Care. The management of menorrhagia: Effective Health Care Bulletin No. 9. Leeds: Nuffield Institute for Health, University of Leeds, 1995.Google Scholar
17.Froberg, D. G., & Kane, R. L.Methodology for measuring health-state preferences, I: Measurement strategies. Journal of Clinical Epidemiology, 1989, 42, 345–54.CrossRefGoogle ScholarPubMed
18.Furlong, W., Feeny, D., Torrance, G. W., et al. Guide to design and development of health-state utility instrumentation, CHEPA Working Paper No.90–9, Hamilton, Ontario: CHEPA, McMaster University, 1990.Google Scholar
19.Gannon, M. J., Holt, E. M., Fairbank, J., et al. A randomized trial comparing endometrial resection and abdominal hysterectomy for the treatment of menorrhagia. British Medical Journal, 1991, 303, 1362–64.CrossRefGoogle ScholarPubMed
20.Gath, D., Osborn, M., Bungay, G., et al. Psychiatric disorder and gynaecological symptoms in middle aged women: A community survey. British Medical Journal, 1987, 294, 213–18.CrossRefGoogle ScholarPubMed
21.Gerard, K., Dobson, M., & Hall, J.Framing and labelling effects in health descriptions: Quality adjusted life years for treatment of breast cancer. Journal of Clinical Epidemiology, 1993, 46, 77–84.CrossRefGoogle ScholarPubMed
22.Gerard, K., & Mooney, G.QALY league tables: Handle with care. Health Economics, 1993, 2, 59–64.CrossRefGoogle ScholarPubMed
23.Hospital episode statistics, vol. 1: Finished consultant episodes by diagnosis, operation and specialty. London: HMSO, 1995.Google Scholar
24.Jenkinson, C., Peto, V., & Coulter, A.Measuring change over time: A comparison of results from a global single item of health status and the multi-dimensional SF-36 health status survey questionnaire in patients presenting with menorrhagia. Quality of Life Research, 1994, 3, 317–21.CrossRefGoogle Scholar
25.Johnnesson, M.The ranking properties of healthy-years equivalents and quality-adjusted life-years under certainty and uncertainty. International Journal of Technology Assessment in Health Care, 1995, 11, 40–48.CrossRefGoogle Scholar
26.Krabbe, P. F. M., Essink-Bot, M. L., & Bonsel, G. J.On the equivalence of collectively and individually collected responses: Standard gamble and time trade-off judgements of health states. Medical Decision Making, 1996, 16, 120–32.CrossRefGoogle Scholar
27.Laupacis, A., Feeny, D., Detsky, A. S., et al. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Canadian Medical Association Journal, 1992, 146, 473–81.Google ScholarPubMed
28.Llewellyn-Thomas, H., Sutherland, H. J., Tibshirani, R., et al. Describing health states: Methodologic issue in obtaining values for health states. Medical Care, 1984, 22, 543–52.CrossRefGoogle ScholarPubMed
29.Loomes, G., & McKenzie, L.The use of QALYs in health care decision making. Social Science and Medicine, 1989, 28, 299–308.CrossRefGoogle ScholarPubMed
30.Maynard, A.Developing the health care market. Economic Journal, 1991,101,1277–86.CrossRefGoogle Scholar
31.McNeil, B. J., Pauker, S. G., Sox, H. C., et al. On the elicitation of preferences for alternative therapies. New England Journal of Medicine, 1982, 306, 1259–62.CrossRefGoogle ScholarPubMed
32.Mehrez, A., & Gafni, A.Quality-adjusted life years, utility theory and healthy-years equivalents. Medical Decision Making, 1989, 9, 142–49.CrossRefGoogle ScholarPubMed
33.Mohide, E. A., Torrance, G. W., Streiner, D. L., et al. Measuring the well-being of family caregivers using the time trade-off technique. Journal of Clinical Epidemiology, 1988, 41, 475–82.CrossRefGoogle ScholarPubMed
34.O'Connor, A. M. C., Boyd, N. F., Warde, P., et al. Eliciting preferences for alternative drug therapies in oncology: Influence of treatment outcome description, elicitation technique and treatment experience on preferences. Journal of Chronic Diseases, 1987, 40, 811–18.CrossRefGoogle ScholarPubMed
35.OECD. OECD Health Data Version 1.5. Paris: OECD, 1993.Google Scholar
36.Peto, V., Coulter, A., & Bond, A.Factors affecting general practitioners’ recruitment of patients into a prospective study. Family Practice, 1993, 10, 207–11.CrossRefGoogle ScholarPubMed
37.Pinion, S. B., Parkin, D. E., & Abramovich, D. R.Randomized trial of hysterectomy, endometrial laser ablation and transcervical endometrial resection for dysfunctional uterine bleeding. British Medical Journal, 1994, 309, 979–83.CrossRefGoogle ScholarPubMed
38.Royal College of Obstetricians and Gynecologists (RCOG) Medical Audit Unit. Fifth bulletin: MISTLETOE report. Manchester: RCOG Medical Audit Unit, 1995.Google Scholar
39.Sculpher, M. J., Bryan, S., Dwyer, N., et al. An economic evaluation of transcervical endometrial resection versus abdominal hysterectomy for the treatment of menorrhagia. British Journal of Obstretrics and Gynecology, 1993, 100, 244–52.CrossRefGoogle ScholarPubMed
40.Sculpher, M. J., Dwyer, N., Byford, S., et al. Randomized trial comparing hysterectomy and transcervical endometrial resection: Effect on health-related quality of life and costs two years after surgery. British Journal of Obstetrics and Gynecology, 1996, 103, 142–49.CrossRefGoogle ScholarPubMed
41.Sculpher, M. J., Michaels, J., McKenna, M., et al. A cost-utility analysis of laser-assisted angioplasty for peripheral arterial occlusions. International Journal of Technology Assessment in Health Care, 1996, 12, 104–25.CrossRefGoogle ScholarPubMed
42.Siddle, N., Sarrel, P., & Whitehead, M.The effect of hysterectomy on the age at ovarian failure: Identification of a subgroup of women with premature loss of ovarian function and literature review. Fertility and Sterility, 1987, 47, 94–100.CrossRefGoogle ScholarPubMed
43.Torrance, G. W.Utility approach to measuring health—related quality of life. Journal of Chronic Diseases, 1987, 40, 593–600.CrossRefGoogle ScholarPubMed
44.Torrance, G. W.Measurement of health state utilities for economic appraisal—A review. Journal of Health Economics, 1986, 5, 1–30.CrossRefGoogle Scholar
45.Torrance, G. W., Thomas, W. H., & Sackett, D. L. A utility maximisation model for evaluation of health care programs. Health Services Research, 1972, 118–33.Google Scholar
46.Vessey, M. P., Villard-Mackintosh, L., McPherson, K., et al. The epidemiology of hysterectomy: Findings in a large cohort study. British Journal of Obstetrics and Gynecology, 1992, 99, 402–07.CrossRefGoogle Scholar
47.Williams, A. The measurement and valuation of health: A chronicle. Center for Health Economics Discussion Paper 136, York: CHE, University of York, 1995.Google Scholar