Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 13 , ISSUE 1 ( January-February, 2021 ) > List of Articles

RESEARCH ARTICLE

Randomized Controlled Trial on Nondescent Vaginal Hysterectomy and Total Laparoscopic Hysterectomy versus Total Abdominal Hysterectomy: A Cost-effectiveness Analysis

Chanil D Ekanayake, Arunasalam Pathmeswaran, Sanjeewa Kularatna, Rasika Herath, Prasantha Wijesinghe

Keywords : Cost-effectiveness analysis, Nondescent vaginal hysterectomy, Randomized controlled trial, Total abdominal hysterectomy, Total laparoscopic hysterectomy

Citation Information : Ekanayake CD, Pathmeswaran A, Kularatna S, Herath R, Wijesinghe P. Randomized Controlled Trial on Nondescent Vaginal Hysterectomy and Total Laparoscopic Hysterectomy versus Total Abdominal Hysterectomy: A Cost-effectiveness Analysis. J South Asian Feder Obs Gynae 2021; 13 (1):31-37.

DOI: 10.5005/jp-journals-10006-1856

License: CC BY-NC 4.0

Published Online: 00-02-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim and objective: Hysterectomy is the commonest major gynecological procedure. There is little information from randomized controlled trials (RCTs) in low-resource settings. Therefore, the aim was to study outcomes and cost-effectiveness of nondescent vaginal hysterectomy (NDVH) and total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH). Materials and methods: A pragmatic multicenter three-arm (49 per arm) RCT was done on patients needing hysterectomy for benign uterine causes. Exclusion criteria were uterus larger than 14 weeks, previous pelvic surgery, any medical illness that contraindicated laparoscopy, and any patient requiring surgery for incontinence or uterovaginal prolapse. The main clinical outcome measure was time to recover. Incremental cost-effectiveness ratios (ICERs) were calculated for NDVH and TLH. Cost-effectiveness acceptability curves of NDVH and TLH were formulated. Results: There was no significant difference in time to recover [median (inter-quartile range) days] [TAH, 35 (30–45) days; NDVH, 32 (24–60) days; and TLH, 30 (26–45) days, p = 0.89]. The direct cost (USD) of TAH [659 (632–687)] was significantly lower compared to NDVH [800 (622–1116)] and TLH [752 (719–795)] (p = 0.03). The ICERNDVH showed TAH was dominant. ICERTLH was 11 USD/day. Worst-case scenario ICERs showed that TAH was dominant. NDVH and TLH were dominant to TAH in the best-case scenario. The probability of cost-effectiveness (threshold of 3 USD/day) was 1.15 versus 0% in the study setting, 0.2 versus 0% in the worst-case scenario, and 76.1 versus 79% in the best-case scenario for NDVH and TLH, respectively. Conclusion: The main clinical outcome, time to recover, showed an insignificant difference between TAH, NDVH, and TLH. However, when considering cost-effectiveness, TAH is likely to be the cost-effective method for the generalist, while the alternate routes NDVH and TLH are likely to be cost-effective in specialized centers.


PDF Share
  1. Whiteman M, Hillis S, Jamieson D, et al. Inpatient hysterectomy surveillance in the United States, 2000-2004: Commentary. Am J Obstet Gynecol 2008;198(34):e1–e7. DOI: 10.1016/j.ajog.2007.05.039.
  2. Hammer A, Rositch AF, Kahlert J, et al. Global epidemiology of hysterectomy: possible impact on gynecological cancer rates. Am J Obstet Gynecol 2015;213(1):23–29. DOI: 10.1016/j.ajog.2015.02.019.
  3. Ekanayake C, Pathmeswaran A, Kularatna S, et al. Cost evaluation, quality of life and pelvic organ function of three approaches to hysterectomy for benign uterine conditions: study protocol for a randomized controlled trial. Trials 2017;18(1):1–10. DOI: 10.1186/s13063-017-2295-7.
  4. American College of Obstetricians and Gynaecologists. Committee opinion 2017. Choosing the route of hysterectomy for benign disease.
  5. Nieboer T, Johnson N, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2009;(3):CD003677. DOI: 10.1002/14651858.CD003677.pub4.
  6. Chaminda SHH, Ekanayake CD, Sriskanthan RS, et al. Outcome of non-descent vaginal hysterectomy at a single centre in Sri Lanka : an observational study. Sri Lanka J Obstet Gynaecol 2015;37(3):42–46. DOI: 10.4038/sljog.v37i3.7763.
  7. Balakrishnan D, Dibyajyoti G. A comparison between non-descent vaginal hysterectomy and total abdominal hysterectomy. J Clin Diagnostic Res 2016;10(1):QC11–QC14. DOI: 10.7860/JCDR/2016/15937.7119.
  8. Abrol S, Rashid S, Jabeen F, et al. Comparative analysis of non-descent vaginal hysterectomy versus total abdominal hysterectomy in benign uterine disorders. Int J Reprod Contracept Obstet Gynecol 2017;6(3):846. DOI: 10.18203/2320-1770.ijrcog20170472.
  9. Grimes C, Henry J, Maraka J, et al. Cost-effectiveness of surgery in low- and middle-income countries: a systematic review. World J Surg 2014;38(1):252–263. DOI: 10.1007/s00268-013-2243-y.
  10. Zwarenstein M, Treweek S, Gagnier J, et al. Improving the reporting of pragmatic trials: an extension of the CONSORT statement. BMJ 2008;337:a2390. DOI: 10.1136/bmj.a2390.
  11. Husereau D, Drummond M, Petrou S, et al. CHEERS: consolidated health economic evaluation reporting standards. Eur J Heal Econ 2013;14(3):367–372. Doi: 10.1016/j.jval.2013.02.010.
  12. Ottosen C, Lingman G, Ottosen L. Three methods for hysterectomy: a randomised, prospective study of short term outcome. BJOG [Internet] 2000;107(111):1380–1385. DOI: 10.1111/j.1471-0528.2000.tb11652.x.
  13. Campbell Collaboration. CCEMG – EPPI-Centre Cost Converter [University College London Website]. 2019. Available from: https://eppi.ioe.ac.uk/costconversion/.
  14. Ekanayake C, Pathmeswaran A, Kularatna S, et al. Challenges of costing a surgical procedure in a lower–middle-income country. World J Surg 2019;43(1):52–59. DOI: 10.1007/s00268-018-4773-9.
  15. Drummond M, Sculpher M, Torrance G, et al. Methods for the economic evaluation of health care programme. Oxford: Oxford University Press; 2005.
  16. Aarts J, Nieboer T, Johnson N, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2015(8):CD003677. DOI: 10.1002/14651858.CD003677.pub5.
  17. Gray A, Clarke P, Wolstenholme J, et al. Applied methods of cost-effectiveness analysis in health care. Oxford: Oxford University Press; 2011.
  18. Centers for Disease Control and Prevention. The NHSN standardized infection ratio (SIR) [Internet] [Cited March 2019]. Available from: https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/nhsn-sir-guide.pdf.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.