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.