Cost-effectiveness analysis
The figures 4 and 5 illustrate cost-effectiveness plans, representing
the differences both in hospitalization costs and in effectiveness of
each surgical procedure at 18 months, compared to the 2G procedure.
Effectiveness is expressed as additional percent of patients without
failure in figure 4A, and as additional percent of patients without
complication in figure 4B.
Hysterectomy is the most effective procedure, as it has the lowest
failure rate, but also the most expensive one, with an incremental
cost-effectiveness ratio (ICER) estimated at \euro24,008 ±
per
additional % of patients without failure at 18 months. It means that,
at 18 months following hysterectomy, it is necessary to pay on average
patients without failure, as compared to 2G. Hysterectomy was conversely
the strategy with the highest complication rate.
Curettage was the least effective procedure, as it was responsible for
20.6% of failure at 18 months, even if it was slightly less expensive
than 2G (\euro-177/patient). 1G procedure was also slightly less
effective than 2G procedure (-2.8% of patients without failure at 18
months) but was less costly (\euro-352 /patient), leading to an ICER
estimated at \euro13,078 per additional % of patients without failure
at 18 months. It means that it is possible to gain \euro13,078/patient
on average, if we accept to lose one % of success.
Regarding complications at 18 months, hysterectomy was dominated, as
this is the strategy with the lowest rate of patients without
complication and the more expensive (Figure 5). As compared to 2G, 1G
and curettage are both slightly more effective (+ 0.4% and +0.5%
patients without complication, respectively) and less expensive
(\euro-352 and \euro-177 per patient, on average respectively),
meaning that these strategies were both dominant.