Costs and health-related quality of life effects of hysterectomy in patients with benign uterine disorders

Objective. To gain knowledge about the utility of hysterectomy in a real-world setting and to relate the utility of the intervention to its costs. Design. Prospective observational study. Setting. University referral hospital in Helsinki. Population. A total of 337 women entering for routine hysterectomy due to a benign disease (210 benign uterine or ovarian cause, 20 endometriosis, 51 uterovaginal prolapse, 56 menorrhagia). Methods. Patients filled in the 15D health-related quality of life (HRQoL) questionnaire before and six months after the operation. Costs were examined from the perspective of secondary care provider. Benefits of surgery were extrapolated till the end of remaining statistical life expectancy of each woman in the prolapse group and until menopause in the other groups. Main outcome measures. HRQoL and cost per quality-adjusted life year (QALY) gained. Results. Mean [standard deviation (SD)] HRQoL score (on a 0-1 scale) in the whole group improved from the preoperative of 0.905 (0.073) to 0.925 (0.077) six months after the operation (p < 0.001). The largest mean (SD) improvement was seen in patients with endometriosis [0.048 (0.067)] followed by those with menorrhagia [0.024 (0.054)], benign uterine or ovarian cause [0.018 (0.071)], and prolapse [0.017 (0.055)]. In the whole group, the intervention produced a mean (SD) of 0.222 (1.270) QALYs at mean (SD) direct hospital cost of (sic)3,138 (2,098). Consequently, the cost per QALY gained in the whole group was (sic)14,135 varying from (sic)3,720 to 31,570 in the disease groups. Conclusions. The cost per QALY gained for hysterectomy for benign uterine disorders is strongly dependent on the indication for surgery.