Clinical Trials Unit, University of Warwick, Coventry, UK.
Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
BJOG. 2018 Jun;125(7):874-883. doi: 10.1111/1471-0528.14950. Epub 2017 Nov 16.
To estimate resource use and costs associated with peripartum hysterectomy for the English National Health Service.
DESIGN/SETTING: Analysis of linked Clinical Practice Research Datalink and Hospital Episodes Statistics (CPRD-HES) data.
Women undergoing peripartum hysterectomy between 1997 and 2013 and matched controls.
Inverse probability weighted generalised estimating equations were used to model the non-linear trend in healthcare service use and costs over time, accounting for missing data, adjusting for maternal age, body mass index, delivery year, smoking and socio-economic indicators.
Primary care, hospital outpatient and inpatient attendances and costs (UK 2015 prices).
The study sample included 1362 women (192 cases and 1170 controls) who gave birth between 1997 and 2013; 1088 (153 cases and 935 controls) of these were deliveries between 2003 and 2013 when all categories of hospital resource use were available. Based on the 2003-2013 delivery cohort, peripartum hysterectomy was associated with a mean adjusted additional total cost of £5380 (95% CI £4436-6687) and a cost ratio of 1.76 (95% CI 1.61-1.98) over 5 years of follow up compared with controls. Inpatient costs, mostly incurred during the first year following surgery, accounted for 78% excluding or 92% including delivery-related costs.
Peripartum hysterectomy is associated with increased healthcare costs driven largely by increased post-surgery hospitalisation rates. To reduce healthcare costs and improve outcomes for women who undergo hysterectomy, interventions that reduce avoidable repeat hospitalisations following surgery such as providing active follow up, treatment and support in the community should be considered.
A large amount of NHS data on peripartum hysterectomy suggests active community follow up could reduce costs, #HealthEconomics.
估算英国国民保健服务体系中与围产期子宫切除术相关的资源利用和成本。
设计/设置：临床实践研究数据库和医院入院统计（CPRD-HES）数据的链接分析。
1997 年至 2013 年间接受围产期子宫切除术的女性及其匹配对照。
使用逆概率加权广义估计方程来模拟随时间变化的医疗服务利用和成本的非线性趋势，同时考虑缺失数据，调整产妇年龄、体重指数、分娩年份、吸烟和社会经济指标。
初级保健、医院门诊和住院就诊次数和费用（2015 年英国价格）。
研究样本包括 1362 名女性（192 例病例和 1170 例对照），她们于 1997 年至 2013 年分娩；其中 1088 名（153 例病例和 935 例对照）于 2003 年至 2013 年分娩，此时可获得所有类别的医院资源利用情况。基于 2003-2013 年分娩队列，围产期子宫切除术与平均调整后总额外成本 5380 英镑（95%CI 4436-6687）相关，且在 5 年的随访期间成本比为 1.76（95%CI 1.61-1.98），与对照组相比。住院费用主要发生在手术后的第一年，不包括分娩相关费用时占 78%，包括分娩相关费用时占 92%。
围产期子宫切除术与医疗保健成本增加相关，主要是由于手术后住院率增加所致。为了降低医疗保健成本并改善接受子宫切除术的女性的结局，应考虑采取干预措施减少术后避免再次住院，如在社区提供积极的随访、治疗和支持。
大量英国国民保健服务体系围产期子宫切除术数据表明，积极的社区随访可能会降低成本，#卫生经济学。
