A randomized trial with a cost-consequence analysis after laparoscopic and abdominal hysterectomy

Objective: To perform a cost-consequence analysis after total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH). Methods: Women scheduled for TAH were randomized prospectively to undergo the procedure by laparoscopic (n = 71) or abdominal (n = 72) surgery. Postoperative health status was assessed using The Medical Outcome Trust 36-Item Short-Form Health Survey questionnaire. The financial accounting system at the hospital and information from the local national health insurance office were used for the economic analysis. We evaluated changes in direct costs (hospital costs) and indirect costs (loss of production value) when performing a laparoscopic hysterectomy instead of an abdominal hysterectomy. Results: Postoperative health status improved significantly faster after TLH than after TAH. The direct costs were 1.7% higher and the indirect costs 50.3% lower for patients undergoing laparoscopic surgery. The total costs were 23.1% lower after laparoscopic hysterectomy. Conclusion: A change in surgical technique from abdominal to laparoscopic hysterectomy was possible without compromising the health status of the patients, and it provided substantial financial benefits to society. (C) 1998 by The American College of Obstetricians and Gynecologists.