| ObjectivesThe paper set a parallel design to evaluate the health economic results of laparoscopic surgery and abdominal surgery for treating uterine leiomyoma. The study aims to compare the clinical effects, medical expenses and patient’s health-related quality of life between the two surgery groups. Finally to provide support in making a proper choice and decision for the treatment.Methods1. Subjects100patients once received a surgery treatment for uterine leiomyoma in Nanfang Hospital, Southern Medical University during April2012to January2013were selected to be participants, among which51patients were under an abdominal surgery (29with myomectomy and21with hysterectomy) and49patients were under a laparoscopic surgery (11with myomectomy and38with hysterectomy).2. Methods2.1InstrumentsHealth-rated quality of life questionnaire for uterine leiomyoma patients was designed, which included factors of demography and life way, a SF-36scale and clinical and cost investigation. SF-36is a brief health measurement scale developed by USA institutes of health, Boston. The SF-36scale has been widely applied in fields as the general population’s quality of life assessment, clinical trails and health policy assessment and so on, and has been shown to good reliability and validity.2.3Quality controlThe research was through a large number of literature reviews and was proved repeatedly. The sampling design and the statistical analysis were both performed according to the design of this subject to make sure the whole study was scientific and reasonable. Before the survey started, all of the investigators received systematic training about the background, purpose, ideas and methods of the study. And the training focused on the content, instructions and Matters needing attention of the questionnaire, to make sure that every investigator had a full understanding of the questionnaire and the study. During the investigation, Investigator explained to subjects how to fill in the scale. Then subjects should asses themselves based on their understanding to each item independently without others’influence. Investigators should not give suggesting guide. After the investigation, we selected the received questionnaires to ensure the quality of final data. Rejected questionnaires which was not logical or accomplishment ratio was under80%. Database was established by Epidata3.02and double input was conducted to make the lowest deviation.2.2Data processing and statisticsBuilt up the database by Epidata3.02and process the data by SPSS18.0after a check with the input data. Described quality of life of participants by Descriptive and Frequency module. Measurement data were expressed with X±S, and T test was for comparison between two groups, F test was for comparison among multiple groups. Homogeneity of variance was tested at the same time, and the Satterthwaite test and Welch test would be used with heterogeneity of variance. Categorical data were expressed with percentage, and was tested with Pearson x2. Selected two tails P value and set a0.05through the whole research. Results1. Basic situation of participants1.1107questionnaires were out and100effective recalled, with the effective rate of93.46%. According to different surgery methods,100chosen patients were divided into two groups:the laparoscope group (49) and the abdominal group (51).1.2Demographic dataThe differences of demographic data between two groups contain age, education, marital status, living situation and health care et al all had no statistical significance (P>0.05).1.3Clinical data①The average number of fibroids:abdominal group2.40±2.51VS laparoscope group2.24±1.15, there are no significant differences (P>0.05);②Average maximum fibroids diameter:abdominal group5.08±1.68cm VS laparoscope group4.83±1.46cm, there are no significant differences (P>0.05);③The average preoperative hemoglobin: abdominal group109.98±25.93g/L VS laparoscope group106.51±24.25g/L, there are no significant differences (P>0.05);④Merge operation:abdominal group15(29.4%) VS laparoscope group14(28.6%), there are no significant differences (P>0.05);⑤Past surgery history:abdominal group24(47.1%) VS laparoscope group18(36.7%), there are no significant differences (P>0.05);⑥Average hospitalization days: abdominal group6.80±1.89d VS laparoscope group6.47±1.47d, there are no significant differences (P>0.05); TAM group6.14±0.92d VS LM group5.36±0.67d, the differences are significant (P<0.05);⑦Average operation time:abdominal group82.10±41.46min VS laparoscope group96.28±38.59min, there are no significant differences (P>0.05); TAM group60.04±17.72min VS LM group81.44±29.23min, the differences are significant (P<0.05);⑧Average operative blood loss:abdominal group81.96±77.05ml VS laparoscope group79.80±82.22ml, there are no significant differences (P>0.05);⑨Average postoperative exhaust time:abdominal group 2.45±0.39d VS laparoscope group1.77±0.48d, the differences are significant (P<0.05);⑩Use of Analgesic pump:abdominal group66.7%VS laparoscope group42.9%, the differences are significant (P<0.05).2. Participants’ quality of life and impact factor analysis2.1The average scores of SF-36of participants①Abdominal group:before operation, physiological score (80.90±11.50), psychological score (73.85±11.95), total score (77.24±8.93); after operation, physiological score (78.81±8.36), psychological score (81.66±4.78), total score (79.44±5.68). The difference of total scores between before and after was no statistical significance, but physiological scores and psychological scores both were statistical significance;②Laparoscope group:before operation, physiological score (82.65±7.18), psychological score (77.24±8.93), total score (79.90±7.04); after operation, physiological score (81.37±7.07), psychological score (83.51±5.19), total score (82.46±5.69). The difference of total scores and physiological scores between before and after was no statistical significance, psychological scores were statistical significance;③Abdominal group VS laparoscope group:There were no statistical significance differences in scores before operation between these two groups. While the differences in scores after operation between all had statistical significance.2.2impact factor analysis①The differences of SF-36scores before operation all had statistical significance among different age, marital status, living situation, breakfast and balanced nutrition (P<0.05).②The differences of SF-36scores after operation all had statistical significance among different living place, breakfast, balanced nutrition, sleeping time, surgery method, operative blood loss and hospitalization days (P<0.05).3. Medical expense and its impact factors3.1Structure analysis of expenseThe average medical expense of abdominal group (14569.51±2952.82yuan) was Significantly lower than it of laparoscope group (17499.15±3634.32yuan). In the structure of expense, medicine and operation were major part in both groups. The percentage of medicine and operation cost were44.11%,20.23%respectively in abdominal group, and34.77%,27.83%in laparoscope group.3.2impact factor analysisThe differences of medical expense were statistical significance among different surgery method, hospitalization days and preoperative hemoglobin (P<0.05).4. Cost-utility analysis (CUA)①Direct medical costs of abdominal group14569.51±2952.82VS laparoscope group17499.15±3634.32, P<0.05; Direct non-medical costs of abdominal group332.35±93.71VS laparoscope group330.61±79.59, P>0.05; Indirect costs of abdominal group6791.55±4208.68VS laparoscope group3102.70±1604.24, P<0.05; Total costs of abdominal group21693.63±4329.40VS laparoscope group20932.61±4007.46, P>0.05;②Pre-operation utility of abdominal group0.7731±0.104VS laparoscope group0.7990±0.070, P>0.05; Four weeks after operation, utility of abdominal group0.7944±0.057VS laparoscope group0.8246±0.057, P<0.05; Obtained utility of abdominal group0.0213±0.094VS laparoscope group0.0256±0.057, P<0.05;③Post-operation QALYs and obtained QALYs of abdominal group were22.2437±1.590and0.5965±2.635respectively; Post-operation QALYs and obtained QALYs of laparoscope group were23.0878±1.594and0.7171±1.606respectively. The differences in post-operation and in obtained QALYs are both significantly between two groups (P<0.05);④Costs for unit obtained QALYs of abdominal group36368.20yuan were much higher than that of laparoscope group29190.64yuan. For each increased obtained QALY, the costs of laparoscope group decreased6310.28yuan by abdominal group.Conclusions1. For treatment of uterine leiomyoma, laparoscopic surgery has better health economic efficiency compared with abdominal surgery. The results has revealed that laparoscopic surgery is more economic and efficiently.2. Compared with the abdominal surgery, laparoscopic surgery can improve quality of life of patients more significantly.3. Main factors that influenced patients’ pre-operation quality of life include age, marital status, living situation, breakfast and balanced nutrition. Main factors that influenced patients’ post-operation quality of life include living place, breakfast, balanced nutrition, sleeping time, surgery method, operative blood loss and hospitalization days.4. Medicine and surgery account for large proportions in treatment expense of uterine leiomyoma. One Way Anova analysis shows that surgery methord, hospital days and preoperative hemoglobin are main influence factors of derect treatment expense. |
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