Diffusion and cost considerations for minimally invasive techniques in gynaecology

Summary

Endometrial resection/ablation using diathermy has diffused quickly and extensively into Australia. Cost advantages over hysterectomy are significant, with costs to the health care system being reduced by an estimated 9–10%, even if more patients are treated surgically for menorrhagia because of the less invasive nature of the technique. Laser and radiofrequency ablation are more expensive that diathermy resection/ablation and have not been used extensively in Australia. Endometrial resection/ablation also reduces time lost from work or other activities by an estimated 11–12%. Laparoscopically assisted hysterectomy is at an early stage of diffusion. It may not offer cost advantages to health care providers, but does have substantial benefits for patients, their families and employers through reducing time lost from work or other activities by an estimated 16%. Diagnostic hysteroscopy has been replacing some dilatation and curettage procedures over the past 4 years. Cost advantages per procedure are small unless diagnostic hysteroscopy is performed in the office but, because of the high volume of procedures performed annually, overall savings to the health care system are likely to be over AUS $10M per year.

Key Words:

• cost
• diffusion
• endometrial ablation
• laparoscopic hysterectomy
• hysteroscopy