An economic evaluation of outpatient versus inpatient polyp treatment for abnormal uterine bleeding

作者：Diwakar L; Roberts T E^*; Cooper N A M; Middleton L; Jowett S; Daniels J; Smith P; Clark T J

来源：BJOG: An International Journal of Obstetrics and Gynaecology , 2016, 123(4): 625-631.

DOI：10.1111/1471-0528.13434

• Cost-effectiveness
• endometrial polyps
• hysteroscopy
• inpatient
• outpatient
• Outpatient Polyp Treatment trial

ObjectivesTo undertake a cost-effectiveness analysis of outpatient uterine polypectomy compared with standard inpatient treatment under general anaesthesia.
DesignEconomic evaluation carried out alongside the multi-centre, pragmatic, non-inferiority, randomised controlled Outpatient Polyp Treatment (OPT) trial. The UK National Health Service (NHS) perspective was used in the estimation of costs and the interpretation of results.
SettingThirty-one secondary care UK NHS hospitals between April 2008 and July 2011.
ParticipantsFive hundred and seven women with abnormal uterine bleeding and hysteroscopically diagnosed endometrial polyps.
InterventionsOutpatient uterine polypectomy versus standard inpatient treatment. Clinicians were free to choose the technique for polypectomy within the allocated setting.
Main outcome measuresPatient-reported effectiveness of the procedure determined by the women's self-assessment of bleeding at 6months, and QALY gains at 6 and 12months.
ResultsInpatient treatment was slightly more effective but more expensive than outpatient treatment, resulting in relatively high incremental cost-effectiveness ratios. Intention-to-treat analysis of the base case at 6months revealed that it cost an additional 9421 per successfully treated patient in the inpatient group and 1,099,167 per additional QALY gained, when compared with outpatient treatment. At 12months, these costs were 22,293 per additional effectively treated patient and 445,867 pound per additional QALY gained, respectively.
ConclusionsOutpatient treatment of uterine polyps associated with abnormal uterine bleeding appears to be more cost-effective than inpatient treatment at willingness-to-pay thresholds acceptable to the NHS.
Tweetable abstractHTA-funded OPT trial concluded that outpatient uterine polypectomy is cost-effective compared with inpatient polypectomy.
Tweetable abstract HTA-funded OPT trial concluded that outpatient uterine polypectomy is cost-effective compared with inpatient polypectomy.

• 出版日期2016-3