BMJ  2004;328:134 (17 January), doi:10.1136/bmj.37942.601331.EE (published 7 January 2004)

Paper

Cost effectiveness analysis of laparoscopic hysterectomy compared with standard hysterectomy: results from a randomised trial

¹ Centre for Health Economics, University of York, Heslington, York YO10 5DD, ² Department of Endo-Gynaecology, University of New South Wales, Royal Hospital for Women, Barker Street, Randwick, NSW 2031, Australia, ³ Clinical Trials and Research Unit, University of Leeds, Leeds LS2 9NG, ⁴ School of Women's and Infants' Health, University of Western Australia, King Edward Memorial Hospital, Perth 6008, Australia

Objective To assess the cost effectiveness of laparoscopic hysterectomy compared with conventional hysterectomy (abdominal or vaginal).

Design Cost effectiveness analysis based on two parallel trials: laparoscopic (n = 324) compared with vaginal hysterectomy (n = 163); and laparoscopic (n = 573) compared with abdominal hysterectomy (n = 286).

Participants 1346 women requiring a hysterectomy for reasons other than malignancy.

Main outcome measure One year costs estimated from NHS perspective. Health outcomes expressed in terms of QALYs based on women's responses to the EQ-5D at baseline and at three points during up to 52 weeks' follow up.

Results Laparoscopic hysterectomy cost an average of £401 ($708; 571) more (95% confidence interval £271 to £542) than vaginal hysterectomy but produced little difference in mean QALYs (0.0015, -0.015 to 0.018). Mean differences in cost and QALYs generated an incremental cost per QALY gained of £267 333 ($471 789; 380 437). The probability that laparoscopic hysterectomy is cost effective was below 50% for a large range of values of willingness to pay for an additional QALY. Laparoscopic hysterectomy cost an average of £186 ($328; 265) more than abdominal hysterectomy, although 95% confidence intervals crossed zero (-£26 to £375); there was little difference in mean QALYs (0.007, -0.008 to 0.023), resulting in an incremental cost per QALY gained of £26 571 ($46 893; 37 813). If the NHS is willing to pay £30 000 for an additional QALY, the probability that laparoscopic hysterectomy is cost effective is 56%.

Conclusions Laparoscopic hysterectomy is not cost effective relative to vaginal hysterectomy. Its cost effectiveness relative to the abdominal procedure is finely balanced.

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Cost-effectiveness of laparoscopic hysterectomy: the effect of length of hospital stay

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