| Objective:To investigate the clinic efficiency of high intensity focused utrasound(HIFU),HIFU combind with GnRHa and Laparoscope for adenomyoma,which is to provide a theoretical basis for the effective treatment of adenomyoma.The health economic analysis of the three treatments is to provide a theoretical basis for the selection of treatments for adenomyoma with good and relatively cheap.Methods:27 cases of adenomyoma who were admitted to the First Afiliated Hospital of Jinan University from August 2013 to May 2018 were collected,who were treated with Laparoscope as Control group.52 cases of adenomyoma who treated in the Zheng Zhou Central Hospital Were selected from April 2014 to August 2018.among them,31 cases who were only treated with HIFU as experimental group 1,another 21 cases who were treated with HIFU combined with GnRHa as experiental group 2.to investigate the clinic efficiency of the three treatments including intraoperative blood loss,operation time,hospital time,the time to resumed working after operation and complications.The follow-up was performed in 3,6,12 months after the treatment of all of the patients.to evaluate the improvement of 3,6,12 months dysmenorrhea,6,12 months menorrhagia and total improvement rate of dysmenorrhea at 3,6,12 months and of menorrhagia at6,12 months after treatment.Health economics analysis was carried out for the three treatment schemes: direct medical cost,direct non-medical cost,indirect cost and total cost were compared for the three treatments;cost-effectiveness analysis was carried out by cost-effectiveness ratio and incremental cost-effectiveness ratio.Results :1 Comparison of clinical efficacy of three treatments(1)The operation time: HIFU group and HIFU combind with GnRHa group was(77.4±32.6)min,(82.9±24.9)min respectively,which were significantly lower than Laparoscopic group(126.9±23.7)min,(P<0.05).(2)Hospital time: HIFU group and HIFU combind with GnRHa group was(10.4±1.7)day,(10.6±2.1)day respectively,the hospital time of which were significantly higher than Laparoscopic group(8.0± 1.9)day(P < 0.05).But the result was influenced by health care policies.(3)The time to resumed working after operation: HIFU group and HIFU combind with GnRHa group was(1.9±0.8)day,(1.8±0.6)day respectively,which were significantly lower than Laparoscopic group(28.9±7.3)day(P<0.05).(4)Complications: there was no serious adverse reactions in the three groups.The most common complications in HIFU group were sacral tail pain and straining feeling in lower abdominal during operation.The most common complications in HIFU combind with were sacral tail pain and straining feeling in lower abdominal and perimenopausal syndromes.The most common complications in Laparoscopic group were 27 patients had lower abdomen pain and incision pain after surgery.(5)Dysmenorrhea scores at 3 months,6 months and 12 months after treatment: compared with before treatment,the dysmenorrhea scores of three groups at 3,6 and 12 months after treatment were significantly lower(P < 0.05).the dysmenorrhea scores of HIFU group was(2.8±2.0)points,(3.2±2.8)points,(3.6±2.8)points respectively.the dysmenorrhea scores of HIFU combined with GnRHa group was(1.8±1.6)points,(1.0±1.6)points,(1.3±1.8)points respectively.the dysmenorrhea scores of Laparoscopic group was(2.3±2.1)points,(2.6±2.6)points,(3.0±2.8)points respectively.dysmenorrhea scores of HIFU combined with GnRHa group were lower than that of the other two groups at 3 months,6 months and 12 months after treatment,and which were significantly lower thanthat of the other two groups at 6 months and 12 months after treatment(P < 0.05).(6)Menstrual volume scores at 6 months and 12 months after treatment: compared with before treatment,the menstrual volume scores of three groups at 6 and 12 months after treatment weresignificantly lower(P < 0.05).the menstrual volume scores of HIFU group was(2.1±1.1)points,(2.3±1.2)points respectively.the menstrual volume scores of HIFU combined with GnRHa group was(1.6±1.0)points,(1.8±1.2)points respectively.the menstrual volume scores Laparoscopic group was(2.3±1.3)points,(2.4±1.3)points respectively.the menstrual volume scores of HIFU combined GnRHa group decreased most.However,there was no statistically significant difference among the three groups(P > 0.05).(7)The effective rate of dysmenorrhea relief in 3 months,6 months and 12 months after treatment: the total effective rate of dysmenorrhea relief in HIFU group was 87.10%,64.52% and54.84% respectively.It in HIFU combined with GnRHa group was 90.48%,95.24% and 93.33%respectively.It was 88.89%,74.07% and 66.67%,respectively in Laparoscopic group.The total effective rate of HIFU combined with GnRHa for dysmenorrhea relief was higher than that of the other two groups,and which was significantly higher than that of the other two groups at 6months and 12 months after treatment(P < 0.05).(8)The effective rate of menorrhagia relief in 6 months and 12 months after treatmentt: the total effective rate of menorrhagia improvement in HIFU group was 70.97% and 67.74% respectively.it was 95.24% and 86.67% respectively in HIFU combined with GnRHa.it was 85.19% and70.37% respectively in Laparoscopic group.After 6 months of treatment,the total effective rate of HIFU combined with GnRHa was significantly higher than that of the other two groups(P<0.05).However,there was no statistically significant difference among the three groups After 12 months of treatment(P > 0.05).2 health economics analysis of three treatments(1)healthcare costs: The direct medical cost,indirect cost and total cost of HIFU group were(11465.5±3504.8)yuan,(3447.1±531.9)yuan and(17225.4±3841.0)yuan respectively.It was(16179.9±2447.2)yuan,(3491.2±631.3)yuan,(22035.5±2810.3)yuan respectively in the HIFU combined GnRHa group.It was(20325.4±3761.4)yuan,(6802.4±1333.3)yuan,(28900.9±4769.5)yuan respectively in Laparoscopic group.Direct medical costs and total costs in the HIFU combined GnRHa group were significantly higher than those in HIFU group(P < 0.05),and there was no significant difference in indirect costs between the two groups(P > 0.05).while the Direct medical costs and total costs in the first two groups were significantly lower than those in the Laparoscopic group.(P < 0.05).(2)Cost-effectiveness rate: In this study,the effective rate of dysmenorrhea relief at 6 months after treatment was selected,and According to which the cost-effectiveness ratio was calculated.cost-effectiveness rate of HIFU group was RMB 17770.44.The it was RMB 16,988.52 in HIFU combined GnRHa group.it was 27440.8 yuan in Laparoscopic group.The cost-effectiveness ratio of HIFU combined with GnRHa was slightly lower than that of HIFU group and significantly lower than that of Laparoscopic group.(3)Incremental cost-effectiveness ratio : Since the cost-effectiveness ratio of HIFU combined with GnRHa was the lowest,HIFU combined with GnRHa scheme as a reference to calculate the incremental cost-effectiveness ratio,which was 15,346.29 yuan for HIFU group and 19582.10 yuan for Laparoscopic group.The incremental cost-effectiveness ratio of HIFU group and Laparoscopic group were significantly higher than that of HIFU combined with GnRHa group.(4)Sensitivity analysis: the cost-effectiveness ratio of the three treatments was calculated by increasing and decreasing 10% of per capita disposable income.It could be seen that The order of the cost-effectiveness ratio of the three treatments had no change,indicating that the above costeffectiveness analysis was reliable.Conclusions:1.Among HIFU combined with GnRHa group,HIFU group and Laparoscopic group are safe and effective treatments for adenomyoma.Compared with aparoscopic adenomyomectomy,HIFU is a non-invasive,shorter operation time and postoperative recovery time and so on.2.The clinical efficiency of HIFU combined with GnRHa for adenomyoma is better than that of HIFU alone and laparoscope,For the relief effect of dysmenorrhea and menorrhagia of which is higher and more lasting then that of the other groups,which proves that HIFU combined with GnRHa is a recommended treatment for adenomyoma.3.Compared with HIFU and laparoscope,for every one case of effective Patient HIFU combined with GnRHa group costs less,and for every additional effective patient,HIFU combined with GnRHa group increases costs less.It can be seen that HIFU combined with GnRHa is better than HIFU and laparoscope at cost-effectiveness ratio and incremental cost-effectiveness ratio,and is a recommended treatment for adenomyoma. |
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