Cost Effectiveness and Health Status after Laparoscopic and Abdominal Hysterectomy

Laparoscopic hysterectomy has rapidly become a routine procedure without a preceding evaluation of its cost effectiveness in comparison with abdominal hysterectomy. Economic analysis must include an assessment of patients' health status. Direct costs (hospital costs) and indirect costs (value of production loss) were calculated for 20 women randomized to total laparoscopic hysterectomy (TLH) and 20 to total abdominal hysterectomy (TAH). Health status was evaluated by scoring responses to standardized questions 1, 3, and 12 weeks after the operation. Direct costs were 7% lower for TLH than for TAH. The shorter hospital stay after TLH more than compensated for the increased costs due to longer operating time. Indirect costs were 52% lower for TLH than for TAH. One and 3 weeks after the operation, limitations in physical and social activity were less pronounced, general mental health was better, and pain less pronounced after TLH compared with TAH. Fewer women considered their hospital stay and sick leave as too short after TLH compared with TAH. We conclude that, compared with TAH, TLH offers economic advantages to the patient, hospital, and society.