THE MANCHESTER-FOTHERGILL PROCEDUREVERSUS VAGINAL HYSTERECTOMY IN THE TREATMENT OF UTERINE PROLAPSE: ANACTIVITY BASED COSTING ANALYSIS
K. HUSBY, C. KROGSGAARDTOLSTRUP, G. LOSE, N. KLARSKOV;
Department of Obstetrics andGynecology, Herlev & Gentofte Univ. Hosp., Herlev, Denmark.
Introduction: Uterus prolapse isa common condition affecting millions of women and imposes greatcosts to the health economy. The costs of treating uterus prolapsesare growing due to aging population. No consensus exists about whichof the numerous surgical techniques to treat uterus prolapse is therecommended.
Objective: The aim of this study was tocompare the hospital costs between the most frequently performedvaginal hysterectomy (VH) and the uterus preserving techniqueManchester-Fothergill procedure (MP) when costs of postoperativeactivities were included. The study was performed alongside aclinical study comparing the two surgical techniques.
Methods:The analysis was based on a historic matched cohort including 590patients (295 pairs) who underwent VH or MP due to uterus prolapseduring 2010-2014. The patients were matched according to age andpreoperative prolapse stage and followed for 20-80 months. Data wascollected from The Danish Urogynecological Database (DugaBase), theDanish Anesthesia Database (DAD), the Danish Hysterectomy Database(DHHD), the Danish National Pathology Registry and Data Bank, andmedical records. Unit costs were obtained from relevant departments,hospital administration or estimated by experts. The hospitalperspective was used for costing the resource use.
Results:The total cost for the first 20 months after operation were for the295 patients with VH-operations 1,036,648 € and for the MP-group683,874 € (p<0.0001), corresponding to 3,514 € and 2,318 €per patient in the VH-group and MP-group respectively. The primaryoperation represented the majority of the total costs accounting for80 % and 82 % of the total costs for the VH-group and MP-grouprespectively. The remainders of the costs derived from relapses (9 %and 4 %), complications (9 % and 9 %), activities concerning urinaryincontinence (2 % and 3 %) and uterus-dependent activities (0 % and 2%). The uterus dependent costs covered activities like menstrualissues, postmenopausal bleeding, uterine cancer, and pathologicalevaluations on tissue from cervix and uterus. Costs to pathologicalevaluations were included regardless if the sample was done at GP,private gynecologist or at any hospital in Denmark. Table 1summarizes the costs while figure 1 shows the costs as a function oftime from primary operation.
Table1: Costs for the first 20 months after primary operation
Postoperativebleeding (superficial or deep)
Unacknowledgedobstruction of ureter
VH= Vaginal hysterectomy, MP = Manchester-Forthergrill Procedure, N= Number of patients, *=Wilcoxon signed-rank test
Conclusions: VH issubstantially more expensive than MP considering the primaryoperation as well as the subsequent activities including relapses,urinary incontinence, and uterus dependent activities for theMP-group. By choosing MP instead of VH an average cost per patient of898 € can be saved on the primary operation and 1196 € if thesubsequent activities are included. In the future this mightinfluence whether VH or MP is chosen to treat uterusprolapse.