Surgical treatment of abnormal uterine bleeding (aub-o,e,n): a cost-effectiveness study using the french hospital claims database

Objective: AUB-O,E,N is treated first with medical management, followed by surgery, which failure or complications have significant burden. The objective was to perform a cost-effectiveness analysis of four surgical strategies, comparing cost and avoided failure rate, using the French PMSI database. Design: Retrospective analysis performed using the French exhaustive national hospital discharge database (PMSI). Population: All incident 35-55 year-old women operated on for four types of AUB-O,E,N surgery (2nd generation, 1st generation, curettage or hysterectomy) between 2009 and 2014 were included. Methods : They were followed to collect rehospitalizations related to failure or complication and their cost, during at least 18 months. Hospital costs were estimated using the French tariffs in 2017\euro. Main Outcome measures : A cost-effectiveness analysis was performed comparing each surgical procedure to 2G, in hospitalization costs and rate of patients without failure. Results : The study included 88,154 patients. At 18 months, mean cost per patient was \euro2,448 for 2G, \euro2,100 for 1G, \euro2,275 for curettage and \euro4,157 for hysterectomy. Hysterectomy was the most effective strategy in terms of absence of failure, but also the most expensive, with an incremental cost of \euro24,008 per additional % of patient without failure. Even with a mean cost similar to 2G, curettage was the least effective strategy with a failure rate reaching 20.6% at 18 months. 1G was less expensive but also less effective than 2G, with an economy of \euro13,078 per % of patient without failure loss. Conclusion: 1G and 2G techniques are the most efficient strategie