Minilaparotomy for the ambulatory management of ovarian cysts
Flynn M, Niloff J M
Record Status
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
Health technology
Minilaparotomy in patients less than 50 years old with complex or persistent ovarian cysts.
Type of intervention
Treatment.
Economic study type
Cost-effectiveness analysis.
Study population
Patients less than 50 years old with complex or persistent ovarian cysts less than or equal to 10cm in maximum size, undergoing cystectomy or oophorectomy.
Setting
Hospital and primary care. The economic study was carried out in Boston, Massachusetts, USA.
Dates to which data relate
The data for the effectiveness analysis were collected between December 1993 and November 1994. No dates were given for the data for the estimation of resources and prices used.
Source of effectiveness data
Effectiveness data were derived from a single study.
Link between effectiveness and cost data
The costing was undertaken retrospectively but it was not reported whether it was undertaken on the same patient sample as that used in the effectiveness analysis.
Study sample
24 patients were included in the study (intervention) group (28 cysts) with the average age of 34 years (range: 25 - 45).
Study design
The study was a case series carried out in a single centre. The duration of follow-up was 3 weeks after surgery. No loss to follow-up was reported.
Analysis of effectiveness
The principle (intention to treat or treatment completers only) used in the analysis of effectiveness was not explicitly reported. The primary health outcomes used were complication rates (from peritoneal contamination from rupture of the cyst or pelvic adhesions), readmissions, and operative time.
Effectiveness results
There were no readmissions. There was one complication, a single case of urinary retention, which was managed on an outpatient basis by bladder catheterization. The mean operative time was 45 minutes (range: 25 - 85).
Clinical conclusions
The authors concluded that the study "data suggest that minilaparotomy is a good alternative to laparoscopy for the outpatient management of patients with ovarian cysts. It is fast and does not require sophisticated equipment or specialised operative expertise. Cyst rupture with contamination of the peritoneal cavity is avoided and the ovary is reconstructed, decreasing the potential for postoperative adhesions".
Measure of benefits used in the economic analysis
No summary benefit measure was identified in the economic study, and only separate clinical outcomes were reported.
Direct costs
The resource use and cost items were not reported separately. The costs items included were operative costs ("equipment and nursing"). The costs reported were ascribed to the institution in which the study was carried out. No other details were provided.
Indirect Costs
Not included.
Currency
US dollars ($).
Sensitivity analysis
No sensitivity analysis was carried out.
Estimated benefits used in the economic analysis
Not applicable.
Cost results
The operative cost of ovarian cystectomy by minilaparotomy was $140. The operative cost of ovarian cystectomy by operative laparoscopy was $1,230.
Synthesis of costs and benefits
Not applicable.
Authors' conclusions
The authors concluded that "minilaparotomy is a safe, cost-effective alternative to laparoscopy for the outpatient surgical management of ovarian cysts".
CRD COMMENTARY - Selection of comparators
The reason for the choice of comparator is clear.
Validity of estimate of measure of benefit
The estimate of measure of benefit used in the economic analysis may not be internally valid mainly due to the type of study (case series, without randomisation or control group) and the low number of subjects included (24 patients with 28 cysts in total).
Validity of estimate of costs
The resource quantities were not reported separately from the prices, no price year was reported, and adequate details of methods of cost estimation were not given. No indirect costs associated with either strategy were included.
Other issues
In view of the lack of randomisation, sensitivity analysis, and statistical analysis of the costs, the results need to be treated with some caution. The issue of generalisability to other settings and countries was not addressed.
Source of funding
None stated.
Bibliographic details
Flynn M, Niloff J M. Minilaparotomy for the ambulatory management of ovarian cysts. American Journal of Obstetrics and Gynecology 1995; 173(6): 1727-1730