Laparoscopic hysterectomy is not cost effective compared with vaginal hysterectomy

Abstract

Question

What is the cost effectiveness of laparoscopic hysterectomy compared with conventional (vaginal or abdominal) hysterectomy?

Study design

Two parallel multicentre randomised controlled trials.

Main results Vaginal hysterectomy:

Laparoscopic hysterectomy was significantly more expensive than vaginal hysterectomy, however there were no differences in quality adjusted life years (QALYs; see Table 1).

Abdominal hysterectomy:

There were no significant differences between abdominal and laparoscopic hysterectomy for cost or QALYs. For each additional QALY, laparoscopic hysterectomy was estimated to cost £267,333 more than vaginal hysterectomy, and £26,571 more than abdominal hysterectomy.

Table 1 Relative cost and effectiveness of laparoscopic versus conventional hysterectomy techniques (£ sterling at 1999/2000 rates).
Comparison	Mean difference in cost (95% CI)	Mean difference in QALYs (95% CI)	ICER
Laparoscopic vs vaginal	£401 (271 to 542)	0.0015(–0.0015 to 0.018)	£267,333
Laparoscopic vs abdominal	£186 (–26 to +375)	0.007(–0.008 to 0.023)	£26,571

QALY, quality adjusted life year; ICER, incremental cost effectiveness ratio (mean difference in cost divided by mean difference in QALYs)

Authors’ conclusions

Laparoscopic hysterectomy does not offer any cost-effectiveness benefit over vaginal hysterectomy. Laparoscopic hysterectomy was similarly cost effective to abdominal hysterectomy.