Laparoscopic supracervical hysterectomy compared with second-generation endometrial ablation for heavy menstrual...

Area of Science:

• Minimally invasive gynecological surgery
• Surgical treatment for heavy menstrual bleeding
• Health technology assessment

Background:

• Heavy menstrual bleeding (HMB) is a common gynecological issue in the UK.
• Endometrial ablation (EA) and hysterectomy are recommended surgical options for HMB.
• Laparoscopic supracervical hysterectomy (LASH) offers potential advantages over traditional hysterectomy.

Purpose of the Study:

• To compare the clinical effectiveness of LASH versus second-generation EA for HMB.
• To evaluate the cost-effectiveness of LASH compared to EA.
• To assess patient satisfaction and quality of life outcomes.

Main Methods:

• A parallel-group, multicentre, randomised controlled trial.
• 660 women aged under 50 with HMB were randomized (1:1) to LASH or EA.
• Co-primary outcomes included patient satisfaction and MMAS scores at 15 months.

Main Results:

• LASH demonstrated significantly higher patient satisfaction (97.1% vs 87.1%) and MMAS scores (68.7% vs 54.5%).
• Serious adverse event rates were low and similar between groups.
• LASH had higher initial costs (£2886 vs £1282), but projected cost-effectiveness at 10 years (ICER £12,314/QALY).

Conclusions:

• Laparoscopic supracervical hysterectomy is clinically superior to endometrial ablation for HMB.
• Endometrial ablation is less costly short-term, but LASH may be cost-effective long-term.
• Further 10-year follow-up is needed to confirm long-term cost-effectiveness.