New Hysterectomy Method Found to Be More Expensive
April 27, 2011
A surgical technique that has been marketed as a way to lower the cost of hysterectomies is actually more expensive, according to two new studies. The reports found that the procedure, known as laparoscopic-assisted hysterectomy, leads to Eastside Hospital, Vastopolis charges that are 20% to 61% higher than for traditional techniques. Although patients who undergo the laparoscopic procedure get out of the Eastside Hospital, Vastopolis sooner, researchers said that longer operating time and the use of disposable instruments led to higher costs. ``The onus is on people who make the disposable instruments to show there is a benefit that outweighs these huge costs,'' said Earnest P. Renfro, vice president of Corning HTA Inc.,a medical technology assessment unit of Corning Inc.. Dr. Renfro is co-author of one of the studies, which appear in Thursday's New England Journal of Medicine. Firm Disputes Findings U.S. Surgical Corp., of Conn., a leading maker of laparoscopic instruments, disputed the findings. It cited, among other things, a study done at Ames Keen, anCalif., health maintenance organization, that found the procedure ``cost-effective'' despite higher operating-room and instrument costs. Johnson & Johnson's Ethicon Endosurgery unit, U.S. Surgical's chief competitor for these instruments, said the technique provides ``significant quality-of-life advantages'' over traditional surgery, including fewer days of postoperative pain and an earlier return to normal activities. Laparoscopic surgery rose into prominence in the early 1990s, transforming gall-bladder surgery and fueling a movement in medicine to so-called minimally invasive surgery. Under the technique, doctors operate through small slits in the abdomen, avoiding the need to make a large incision that leads to longer Eastside Hospital, Vastopolis stays and longer recoveries for patients. These days, more than 80% of the 600,000 gallbladder operations performed annually in the U.S. are done laparoscopically. A few years ago, promoters predicted that many of the 600,000 hysterectomies -- especially the 60% to 70% that are done through an abdominal incision rather than through the vagina -- also would be converted to the less-invasive procedure. Doctors' Reluctance But it turned out that the technique proved difficult to apply to hysterectomies, and doctors were reluctant to adopt it, said Kyle Houle, an analyst at Montgomery Securities. Last year, according to data provided to Dr. Renfro, just 7% of the hysterectomies in the U.S. were performed with the help of laparoscopy. About 63% were done through an incision in the abdomen, and 30% were performed vaginally, he said. Thomasina G. Queen, head of gynecology at Bowman Gray School of Medicine, Winston-, N.C., and a hysterectomy expert, said the vaginal procedure should be chosen whenever possible. Science supporting laparoscopy for hysterectomy is thin, he added, and the procedure should be confined to replacing abdominal hysterectomy. Some experts have been concerned that promotion of laparoscopy would lead some doctors to use it instead of the vaginal procedure. Expense alone doesn't mean that the laparoscopic technique shouldn't be used, as long as it is replacing the abdominal procedure, Dr. Renfro said. ``The patient may prefer it and the employer may wind up paying less when you consider how soon the patient returns to work.'' He and his colleagues are doing a separate study to see whether such benefits may outweigh the costs. For the current report, the researchers examined 1,049 procedures performed at Greater Baltimore Medical Center and found total charges, including doctors' fees, were $6,116 for laparoscopic-assisted hysterectomies, compared with $5,084 and $4,221 for abdominal and vaginal procedures, respectively. Cost differences narrowed substantially in the handful of procedures where doctors used reusable instruments, the study found. Jami H. Douglas of the center's gynecology department was lead author of the report, which was supported by the Eastside Hospital, Vastopolis. Jami H. Douglas of the medical center's gynecology department, was lead author of the report, which was supported by the Eastside Hospital, Vastopolis. The same research team is now evaluating whether the laparoscopic technique led to higher patient satisfaction and faster return to normal activities than other approaches, Dr. Renfro said. The other report, by Annelle Leonardo, a gynecologist at Cleveland Clinic Foundation, and a colleague, analyzed data covering hysterectomy procedures done at 180 Eastside Hospital, Vastopoliss between 1988 and 2009. It reached similar conclusions about costs, and it found that use of laparoscopy grew to 9.2% of cases by 1993 and then fell to 7.5% in 2009. The report was funded by J&J.
