Manchester–Fothergill procedure versus vaginal hysterectomy with uterosacral ligament suspension: an activity-based costing analysis

TY - JOUR

T1 - Manchester–Fothergill procedure versus vaginal hysterectomy with uterosacral ligament suspension

T2 - an activity-based costing analysis

AU - Husby, Karen Ruben

AU - Tolstrup, Cæcilie Krogsgaard

AU - Lose, Gunnar

AU - Klarskov, Niels

PY - 2018

Y1 - 2018

N2 - Introduction and hypothesis: Pelvic organ prolapse (POP) is a common diagnosis that imposes high and ever-growing costs to the healthcare economy. Numerous surgical techniques for the treatment of POP exist, but there is no consensus about which is the ideal technique for treating apical prolapse. The aim of this study was to estimate hospital costs for the most frequently performed operation, vaginal hysterectomy with uterosacral ligament suspension (VH) and the uterus-preserving Manchester–Fothergill procedure (MP), when including costs of postoperative activities. Methods: The study was based on a historical matched cohort including 590 patients (295 pairs) who underwent VH or MP during 2010–2014 owing to apical prolapse. The patients were matched according to age and preoperative prolapse stage and followed for a minimum of 20 months. Data were collected from four national registries and electronic medical records. Unit costs were obtained from relevant departments, hospital administration, calculated, or estimated by experts. The hospital perspective was applied for costing the resource use. Results: Total costs for the first 20 months after operation were 3,514 € per VH patient versus 2,318 € per MP patient. The cost difference between the techniques was 898 € (95% confidence interval [CI]: 818–982) per patient when analyzing the primary operation only and 1,196 € (CI: 927–1,465) when including subsequent activities within 20 months (p < 0.0001). Conclusions: The MP is substantially less expensive than the commonly used VH from a 20-month time perspective. Healthcare costs can be reduced by one third if MP is preferred over VH in the treatment of apical prolapse.

AB - Introduction and hypothesis: Pelvic organ prolapse (POP) is a common diagnosis that imposes high and ever-growing costs to the healthcare economy. Numerous surgical techniques for the treatment of POP exist, but there is no consensus about which is the ideal technique for treating apical prolapse. The aim of this study was to estimate hospital costs for the most frequently performed operation, vaginal hysterectomy with uterosacral ligament suspension (VH) and the uterus-preserving Manchester–Fothergill procedure (MP), when including costs of postoperative activities. Methods: The study was based on a historical matched cohort including 590 patients (295 pairs) who underwent VH or MP during 2010–2014 owing to apical prolapse. The patients were matched according to age and preoperative prolapse stage and followed for a minimum of 20 months. Data were collected from four national registries and electronic medical records. Unit costs were obtained from relevant departments, hospital administration, calculated, or estimated by experts. The hospital perspective was applied for costing the resource use. Results: Total costs for the first 20 months after operation were 3,514 € per VH patient versus 2,318 € per MP patient. The cost difference between the techniques was 898 € (95% confidence interval [CI]: 818–982) per patient when analyzing the primary operation only and 1,196 € (CI: 927–1,465) when including subsequent activities within 20 months (p < 0.0001). Conclusions: The MP is substantially less expensive than the commonly used VH from a 20-month time perspective. Healthcare costs can be reduced by one third if MP is preferred over VH in the treatment of apical prolapse.

KW - Activity-based costing analysis

KW - Apical prolapse

KW - Economic analysis

KW - Manchester–Fothergill procedure

KW - Pelvic organ prolapse

KW - Vaginal hysterectomy

U2 - 10.1007/s00192-018-3575-9

DO - 10.1007/s00192-018-3575-9

M3 - Journal article

C2 - 29480429

AN - SCOPUS:85042547265

SN - 0937-3462

VL - 29

SP - 1161

EP - 1171

JO - International Urogynecology Journal

JF - International Urogynecology Journal

IS - 8

ER -