Cost-Utility Analysis of Total Abdominal Versus Total Laparoscopic Hysterectomy in a Thai University Hospital

Abstract

Objective: The goal of this research was to perform a cost-utility analysis of abdominal hysterectomy (AH), compared with laparoscopic hysterectomy (LH), at the Ramathibodi Hospital, of Mahidol University, in Bangkok, Thailand, from a societal perspective. Materials and Methods: A prospective study was conducted from May 2018 to May 2019 with 112 participants (n = 56 for each group), ages 35-50, who underwent AH or LH for benign conditions. Health-utility value was evaluated by the EQ-5D-5L [EuroQual-5 Dimensions-5 Levels] questionnaire upon admission and at 6 weeks and 3 month post the operations. Direct costs, direct nonmedical costs, indirect costs, health-related quality of life (QoL), and incremental cost-effectiveness ratio (ICER) values were compared between AH and LH. A 1-way sensitivity analysis also identified cost variables that affected ICER most. Results: Patients who had LH had lower estimated blood losses, shorter hospital stays, and fewer days off after surgery, but had longer operation times, than patients who had AH. There was no significant difference in rates of complications between the 2 groups. The direct medical costs for LH were higher than for AH (median [minimum-maximum], $1836.00 [$1082.80-$3072.70] versus $1151.30 [800.10-2529.50]; p < 0.001), but no significant differences were found for direct nonmedical costs (p = 0.274) and indirect costs (p = 0.729) between AH and LH. The ICER at 6 weeks post operation was $647.1 per 1 additional utility score. The factor that affected ICER most was direct medical costs of LH. Conclusions: LH has several clinical advantages over AH for patients with benign gynecologic conditions. However, when comparing LH to AH in Thailand, LH seemed to be less cost-effective relative to LH in Western countries because of the higher direct costs of LH than AH in Thailand. The incremental cost for a better QoL for patients undergoing laparoscopic surgery was $647.10 for 1 extra unit of QoL per day. Direct medical costs of LH was the most-important factor affecting incremental cost.