Clinical And Health Economics Evaluation Of Patients With Hysteromyoma Performing HIFU Or LM

Objective: We undertook a retrospective research of medical records to carryout health economics evaluation of patients with hysteromyoma performingHIFU and LM on basis of cost-effectiveness analysis, and hope to provide atheoretical basis for medical and health decision-making.Methods: From Aug.2012to Aug.2013,69cases with hysteromyomaunderwent HIFU and67cases submitted laparoscopic myomectomy (LM) inThe Second Hospital of Hebei Medical University were retrospectivelyassessed. The patients were divided to four groups according to the therapyand the maximum diameter(D) of the hysteromyoma：HIFU-1group(D＜6cm,n=43)、HIFU-2group(D≥6cm, n=26)、LM-1group(D＜6cm, n=23)、LM-2group(D≥6cm, n=44). Compared the clinical indexes including operativetime, hospital stay, complication rate etc and costs of the HIFU-1with LM-1，meanwhile the HIFU-2with LM-1, moreover carried out cost-effectivenessanalysis.Results: There were no statistically significant differences in the average age,proportion of surgical history, the uterine body size and the largest diameter ofhysteromyoma between HIFU-1group and LM-1group[39.51y vs38.96y, P＞0.05;33%(14/43) vs44%(7/23), P＞0.05;7.70weeks vs7.61, P＞0.05;48.98mm vs51.30mm, P＞0.05]; There were no statistically significantdifferences in the average age, proportion of surgical history, the uterine bodysize and the largest diameter of hysteromyoma between HIFU-2group andLM-2group[41.81y vs38.98y，P＞0.05；23%(6/26) vs32%(14/44), P＞0.05；10.07weeks vs10.07weeks, P＞0.05;76.12mm vs77.45mm, P＞0.05].The length of hospital stay, post-operative hospital stay, operating time, timeof using antibiotics via vena，sick leave in HIFU-1group were significantlyshorter than LM-1group [5.02d vs7.61d, P＜0.01;2.74d vs5.26d, P＜0. 01;48.51min vs89.35min, P＜0.01;1.32d vs3.09d, P＜0.01;15.88d vs38.26d(P＜0.01)]. The length of hospital stay, hospital stay after operation,operating time, time of using antibiotics via vena，sick leave in HIFU-2groupwere significantly shorter than LM-2group[5.81d vs8.50d, P＜0.01;2.88dvs5.70d, P＜0.01;62.15min vs122.16min, P＜0.01;1.31d vs2.95d, P＜0.01;10.46d vs43.11d(P＜0.01)]. There was no statistically significantdifferences in clinical effective rate between HIFU-1group and LM-1group[93%(41/43) vs96%(22/23), P＞0.05], and the same to the HIFU-2group and LM-2group[6%(25/26) vs95%(42/44), P＞0.05]; There was noserious complication in all groups, adverse reaction in HIFU groups includingleg numbness3%(2/69), vaginal bloody discharge17%(12/69), sacroiliac orbuttock pain5.8%(4/69); adverse reaction in LM groups includingpost-operative morbidity19%(13/67)，dys-wound healing16%(11/67). Theaverage total cost and cost of hospitalization in HIFU-1group weresignificantly higher than those in LM-1group[17953.43yuan vs15883.26yuan(P＜0.01);16149.18yuan vs12351.09yuan(P＜0.01)], but thesalary loss of sick leave were significantly lower[1459.35yuan vs3009.75yuan(P＜0.01)]. The average total cost and cost of hospitalization in HIFU-2group were significantly higher than those in LM-2group[19087.10yuan vs17253.89yuan(P＜0.01);17445.86yuan vs13287.08yuan(P＜0.01)], butthe salary loss of sick leave were significantly lower[1242.49yuan vs3383.20yuan(P＜0.01)]. HIFU-1group compared with LM-1group: we need to pay1466.44yuan for shorten one day of hospital stay,169.71yuan for shorten oneday of sick leave. HIFU-2group compared with LM-2group: we need to pay1546.01yuan for shorten one day of hospital stay,127.37yuan for shorten oneday of sick leave.Conclusions:1It was safe and efficacy that HIFU ablation was used in treatment ofhysteromyoma.2The LM has the better cost-effectiveness radio at present, but the HIFUhas a better future.