An economic evaluation of outpatient versus inpatient polyp treatment for abnormal uterine bleeding

Research output: Contribution to journalArticle

Abstract

Objectives
To undertake a cost-effectiveness analysis of outpatient uterine polypectomy compared with standard inpatient treatment under general anaesthesia.

Design
Economic evaluation carried out alongside the multi-centre, pragmatic, non-inferiority, randomised controlled Outpatient Polyp Treatment (OPT) trial. The UK National Health Service (NHS) perspective was used in the estimation of costs and the interpretation of results.

Setting
Thirty-one secondary care UK NHS hospitals between April 2008 and July 2011.

Participants
Five hundred and seven women with abnormal uterine bleeding and hysteroscopically diagnosed endometrial polyps.

Interventions
Outpatient uterine polypectomy versus standard inpatient treatment. Clinicians were free to choose the technique for polypectomy within the allocated setting.

Main outcome measures
Patient-reported effectiveness of the procedure determined by the women's self-assessment of bleeding at 6 months, and QALY gains at 6 and 12 months.

Results
Inpatient treatment was slightly more effective but more expensive than outpatient treatment, resulting in relatively high incremental cost-effectiveness ratios. Intention-to-treat analysis of the base case at 6 months revealed that it cost an additional £9421 per successfully treated patient in the inpatient group and £ 1,099,167 per additional QALY gained, when compared with outpatient treatment. At 12 months, these costs were £22,293 per additional effectively treated patient and £445,867 per additional QALY gained, respectively.

Conclusions
Outpatient treatment of uterine polyps associated with abnormal uterine bleeding appears to be more cost-effective than inpatient treatment at willingness-to-pay thresholds acceptable to the NHS.

Details

Original languageEnglish
JournalBJOG
Early online date25 May 2015
Publication statusE-pub ahead of print - 25 May 2015

Keywords

  • OPT trial, cost-effectiveness, Hysteroscopy, endometrial polyps, Inpatient, outpatient