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Experience with shared decision making in gynaecological practice: treatment decisions in patients with dysfunctional
Gert Jan van der Wilt1, Carina F M Meulendijks, Robbert F A Thijssen
1Department of Medical Technology Assessment, University Medical Centre St Radboud, PO Box 9101, 6500 HB Nijmegen, The Netherlands. g.vanderwilt@mta.umcn.nl
Insights
Introducing a blood loss chart significantly reduced re-treatments for dysfunctional uterine bleeding by 50%. This tool supports treatment selection, proving feasible and cost-effective for women's health.
Area of Science:
- Gynecology
- Women's Health
- Medical Devices
Background:
- Dysfunctional uterine bleeding (DUB) poses a significant challenge in women's health.
- Accurate assessment of blood loss is crucial for effective treatment selection.
- Current methods may lead to suboptimal treatment choices and re-treatments.
Purpose of the Study:
- To evaluate the impact of a novel blood loss chart on treatment selection for DUB.
- To assess the feasibility and cost-effectiveness of using a blood loss chart in clinical practice.
Main Methods:
- A mixed-methods approach combining retrospective chart review, prospective observational study, and decision modeling.
- Analysis of treatment outcomes and re-treatment rates before and after chart implementation.
- Cost-effectiveness analysis using quality-adjusted life year (QALY) ratios.
Main Results:
- The introduction of the blood loss chart led to a 50% reduction in re-treatments within one year (25% to 12.5%).
- The chart use resulted in a higher expected value and reduced overall costs.
- A more favorable cost/QALY ratio was observed with the use of the blood loss chart.
Conclusions:
- The blood loss chart is a feasible aid for treatment selection in women with DUB.
- Despite an additional outpatient visit, the chart's benefits in initial treatment and reduced re-treatment rates offset associated costs.
- The tool demonstrates potential for improving patient outcomes and healthcare economics in DUB management.
Objective:
To study the impact of introducing a blood loss chart as a means to support treatment selection in women with dysfunctional uterine blood loss.
Study Design:
Retrospective chart review, prospective observational study, and decision modelling.
Results:
Introduction of a blood loss chart resulted in a 50% reduction of re-treatments within 1 year (from 25% to 12.5%). The use of the blood loss chart resulted in a slightly higher expected value and lower costs, which is reflected in a more favourable cost/quality adjusted life year (QALY) ratio.
Conclusion:
The use of a blood loss chart as an aid in treatment selection in women with dysfunctional uterine blood loss is feasible. Although its use requires an extra outpatient visit, the associated extra costs are off-set by its impact on initial treatment selection, and, in particular, on the probability of re-treatment within 1 year of follow-up.