Farquhar Cynthia, Brown Paul M, Furness Sue
Cochrane Menstrual Disorders and Subfertility Group, Department of Obstetrics and Gynaecology, National Women's Hospital, University of Auckland, New Zealand.
BJOG. 2002 Nov;109(11):1273-80. doi: 10.1046/j.1471-0528.2002.01224.x.
To conduct a cost effectiveness analysis of pre-operative gonadotrophin releasing hormone agonists (GnRHa) in women with uterine fibroids undergoing hysterectomy or myomectomy.
A cost effectiveness analysis using the effectiveness data from a systematic review of GnRHa.
Secondary care.
Women with uterine fibroids undergoing hysterectomy or myomectomy and women volunteers.
Effectiveness data were used from a systematic review to construct a model and to calculate the cost per surgical outcome avoided. In order to evaluate the value women place on the outcome, a willingness to pay analysis of women volunteers was undertaken.
(a) The cost of avoiding abdominal hysterectomy and the cost of avoiding a vertical incision at either hysterectomy or myomectomy; (b) The value that women place on avoiding abdominal hysterectomy and on avoiding a vertical incision at either hysterectomy or myomectomy. All costs are in NZ dollars.
For hysterectomy, the additional cost of treatment with GnRHa was NZ$1190 per case. The cost of avoiding one abdominal procedure was NZ$4577 per case and the cost of avoiding one vertical incision was NZ$6263. For a myomectomy, the additional cost of treatment with GnRHa was NZ$1535 per case. The cost of avoiding one vertical incision was NZ$4651 per case. These costs exceeded the benefit women placed on the outcomes.
Although the pre-operative use of GnRHa results in benefits which include less frequent abdominal incisions in the case of hysterectomy and less frequent vertical incisions in the case of myomectomy, the benefits do not justify the costs. This study highlights the importance of considering both the benefits and costs in health care decisions.
对接受子宫切除术或肌瘤切除术的子宫肌瘤女性患者术前使用促性腺激素释放激素激动剂（GnRHa）进行成本效益分析。
利用对GnRHa系统评价的有效性数据进行成本效益分析。
二级医疗保健机构。
接受子宫切除术或肌瘤切除术的子宫肌瘤女性患者及女性志愿者。
利用系统评价中的有效性数据构建模型，并计算避免每种手术结局的成本。为评估女性对该结局的重视程度，对女性志愿者进行了支付意愿分析。
（a）避免腹式子宫切除术的成本以及避免在子宫切除术或肌瘤切除术中采用纵切口的成本；（b）女性对避免腹式子宫切除术以及避免在子宫切除术或肌瘤切除术中采用纵切口的重视程度。所有成本均以新西兰元计。
对于子宫切除术，GnRHa治疗的额外成本为每例1190新西兰元。避免一次腹部手术的成本为每例4577新西兰元，避免一次纵切口的成本为6263新西兰元。对于肌瘤切除术，GnRHa治疗的额外成本为每例1535新西兰元。避免一次纵切口的成本为每例4651新西兰元。这些成本超过了女性对这些结局所赋予的益处。
尽管术前使用GnRHa带来了益处，包括子宫切除术时腹部切口频率降低以及肌瘤切除术时纵切口频率降低，但这些益处并不足以证明成本的合理性。本研究强调了在医疗保健决策中同时考虑益处和成本的重要性。
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