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Laparoscopic surgery for ectopic pregnancies: technology assessment and public health implications
1Department of Obstetrics and Gynecology, University of Alabama, Birmingham 35233.
Objectives:
To review the process by which technology is assessed in the United States and to use the principles elicited to compare laparotomy versus laparoscopy for the treatment of ectopic pregnancies (EPs).
Participants:
Patients with an EP documented in 1987 in the United States.
Methods:
Determining and reviewing the applicability, safety, efficacy, cost-effectiveness, cost-benefit, and availability of laparoscopic surgery for an EP.
Results:
Laparoscopic surgery is applicable to at least 80% of patients, representing some 70,400 women in 1987. Safety and efficacy of laparoscopy are comparable with laparotomy, with the exception of a possible increase in the frequency of persistent EPs, if a conservative procedure is performed endoscopically. Dollar for dollar laparoscopy is more cost-effective than laparotomy for the treatment of EPs, with reduced hospitalization and recovery time, and improved cosmesis. Cost-benefit analysis indicates a savings of $105,600,000.00 in direct hospitalization costs and $65,000,000.00 in increased employer or patient income, because of a more rapid return to work time. Furthermore, savings in decreased home care requirements could not be calculated. The use of laparoscopic surgery in all potential candidates with an EP in 1987 would have resulted in an increased expenditure of $28,160,000.00 annually for additional equipment and $3,520,000.00 for the repeat laparotomies required to treat the excess number of persistent EPs. The expense of training physicians and operating room staffs in this technique could not be quantified. Overall, availability of this procedure was felt to be considerably less than 30% of affected patients.
Conclusions:
Overall, the use of laparoscopic surgery in all eligible (> or = 80%) patients with an EP in 1987 in the United States would have resulted in a savings of approximately $138,920,000.00 for that year alone. Currently, there is a tremendous deficiency in the availability of this cost-effective procedure, contributing to the escalating costs of medical care.