Ransom S B, McNeeley S G, White C, Diamond M P
Department of Obstetrics and Gynecology, Henry Ford Health Systems Eastern Region, 131 Kercheval, Grosse Point Farms, MI 48236, USA.
J Am Assoc Gynecol Laparosc. 1996 Nov;4(1):29-32. doi: 10.1016/s1074-3804(96)80105-8.
To assess the cost of four procedures performed to treat primary menorrhagia.
Retrospective analysis. Setting. A 394-bed womens' teaching hospital.
Eighty healthy women undergoing one of the four procedures. Interventions. The study patients were equally divided among vaginal hysterectomy (VH), total abdominal hysterectomy (TAH), laparoscopic-assisted vaginal hysterectomy (LAVH), and endometrial ablation (EA).
Endometrial ablation was associated with significantly reduced hospital costs and a shorter recovery period than the other modalities. Hospital costs were less for VH and return to work was quicker after LAVH and VH. This study did not evaluate long-term failures or complications unless they occurred within the first 2 months after the procedure.
Among women who could be treated by any of these techniques, VH was significantly more cost effective for the permanent management of primary menorrhagia than LAVH and TAH. The cost efficiency of EA was clearly implied, but further studies must be completed to evaluate the long-term costs associated with treatment failures. Although physicians should not choose a procedure based exclusively on cost, the expense of a less efficient or more costly procedure may affect a hospital's competitiveness in this era of managed care.
评估用于治疗原发性月经过多的四种手术的成本。
回顾性分析。地点：一家拥有394张床位的女性教学医院。
80名健康女性接受了四种手术中的一种。干预措施：研究患者被平均分为四组，分别接受阴道子宫切除术（VH）、全腹子宫切除术（TAH）、腹腔镜辅助阴道子宫切除术（LAVH）和子宫内膜去除术（EA）。
与其他手术方式相比，子宫内膜去除术的住院成本显著降低，恢复期更短。VH的住院成本较低，LAVH和VH术后恢复工作更快。本研究未评估长期失败或并发症情况，除非这些情况发生在手术后的前两个月内。
在可采用这些技术进行治疗的女性中，对于原发性月经过多的永久性治疗，VH相比LAVH和TAH具有显著更高的成本效益。EA的成本效益明显，但必须完成进一步研究以评估与治疗失败相关的长期成本。尽管医生不应仅基于成本来选择手术方式，但在这个管理式医疗时代，效率较低或成本较高的手术的费用可能会影响医院的竞争力。
