SURGICAL TREATMENT OF ABNORMAL UTERINE BLEEDING (AUB-O,E,N): A
COST-EFFECTIVENESS STUDY USING THE FRENCH HOSPITAL CLAIMS DATABASE
Abstract
Objective: AUB-O,E,N is treated first with medical management, followed
by surgery, which failure or complications have significant burden. The
objective was to perform a cost-effectiveness analysis of four surgical
strategies, comparing cost and avoided failure rate, using the French
PMSI database. Design: Retrospective analysis performed using the French
exhaustive national hospital discharge database (PMSI). Population: All
incident 35-55 year-old women operated on for four types of AUB-O,E,N
surgery (2nd generation, 1st generation, curettage or hysterectomy)
between 2009 and 2014 were included. Methods : They were followed to
collect rehospitalizations related to failure or complication and their
cost, during at least 18 months. Hospital costs were estimated using the
French tariffs in 2017\euro. Main Outcome measures : A
cost-effectiveness analysis was performed comparing each surgical
procedure to 2G, in hospitalization costs and rate of patients without
failure. Results : The study included 88,154 patients. At 18 months,
mean cost per patient was \euro2,448 for 2G, \euro2,100 for 1G,
\euro2,275 for curettage and \euro4,157 for hysterectomy.
Hysterectomy was the most effective strategy in terms of absence of
failure, but also the most expensive, with an incremental cost of
\euro24,008 per additional % of patient without failure. Even with a
mean cost similar to 2G, curettage was the least effective strategy with
a failure rate reaching 20.6% at 18 months. 1G was less expensive but
also less effective than 2G, with an economy of \euro13,078 per % of
patient without failure loss. Conclusion: 1G and 2G techniques are the
most efficient strategie