Cost-Analysis Comparison of Outpatient See-and-Treat Hysteroscopy Service with Other Hysteroscopy Service Models

Sarıdoğan, Ertan; Tilden, Dominic; Sykes, David; Davis, Neil M.; Subramanian, Dhinagar

doi:10.1016/j.jmig.2010.03.009

Cited by 74 publications

(41 citation statements)

References 24 publications

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“…An economic analysis of this approach suggests that this is more cost-effective to the health service compared to routine general anaesthetic procedures [23].…”

Section: Managementmentioning

confidence: 99%

Endometrial Polyps and Subfertility

Chami

Sarıdoğan

2016

J Obstet Gynecol India

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Endometrial polyps are frequently seen in subfertile women, and there is some evidence suggesting a detrimental effect on fertility. How polyps contribute to subfertility and pregnancy loss is uncertain and possible mechanisms are poorly understood. It may be related to mechanical interference with sperm transport, embryo implantation or through intrauterine inflammation or altered production of endometrial receptivity factors. Different diagnostic modalities such as two-or three-dimensional transvaginal ultrasound, saline infusion sonography or hysteroscopy are commonly used to evaluate endometrial polyps with good detection rates. The approach of clinicians towards polyps detected during infertility investigations is not clearly known, and it is quite likely that there is wide variation amongst different groups. Most clinicians suggest hysteroscopy and polyp removal if a polyp is suspected before stimulation for in vitro fertilisation or a frozen embryo transfer cycle. However, the clinical evidence and benefit of different management options during assisted reproduction technology cycles are conflicting. Currently, there is insufficient evidence to recommend one particular option over others when a polyp is suspected during stimulation for in vitro fertilisation. A properly designed randomized controlled trial is needed to determine the best treatment option. In this article, we present the available evidence and our practice related to different diagnostic modalities and management options.

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“…An economic analysis of this approach suggests that this is more cost-effective to the health service compared to routine general anaesthetic procedures [23].…”

Section: Managementmentioning

confidence: 99%

Endometrial Polyps and Subfertility

Chami

Sarıdoğan

2016

J Obstet Gynecol India

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“…1 It offers a method for directly visualizing uterine pathology without the need for general anesthesia and the use of an operating room (OR), thereby decreasing procedure times and lowering risks and costs. 2 The advent of small-diameter, flexible hysteroscopes has offered another layer of success in assessing abnormal uterine bleeding in the outpatient setting because of its increased tolerability and safety and decreased need for anesthesia compared with the use of rigid hysteroscopes. 3 …”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Office Hysteroscopy for Abnormal Uterine Bleeding

Moawad

Santamaria

Johnson³

et al. 2014

JSLS

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Background and Objectives:Office diagnostic hysteroscopy allows physicians to directly view the endometrial cavity, tubal ostia, and endocervical canal without taking the patient to the operating room (OR). We sought to determine whether office hysteroscopy performed to evaluate abnormal uterine bleeding decreases the need for hysteroscopy performed in the OR and the associated financial and risk implications.Methods:One hundred thirty patients who underwent office diagnostic hysteroscopy between January 2009 and March 2012 at 2 outpatient clinics in an academic university setting were identified. Records were reviewed from paper charts and electronic medical records. Hospital charts for patients who required hysteroscopy in the OR were reviewed as well. Charge estimates were obtained from our billing department. These results were analyzed for review of the data.Results:Seventy-five of the 130 women who underwent diagnostic office hysteroscopy for abnormal bleeding did not need to undergo hysteroscopy in the OR. This represents estimated savings of $1498 per patient (95% confidence interval, $1051–$1923) in procedure charges. Among the 55 women who underwent OR hysteroscopy, there was 71% agreement between findings on hysteroscopy in the office and in the OR.Conclusion:Office hysteroscopy is a useful diagnostic tool that can help decrease the rate of diagnostic hysteroscopy in the OR under anesthesia when used in a select patient population.

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“…The use of this technique has probably had a positive influence on implementation of outpatient hysteroscopy for other indications. Third, literature shows that outpatient hysteroscopy is the most cost-effective method of hysteroscopy [24]. …”

Section: Discussionmentioning

confidence: 99%

“…Compared to the inpatient setting, patients treated in the outpatient setting recover faster, leading to a decrease in time away from home and work [24]. Nevertheless, our previous study revealed that in 2003, outpatient hysteroscopic polypectomy in the Netherlands was not practiced on a large scale (29% of gynecologists).…”

Section: Introductionmentioning

confidence: 99%

Current practice in the removal of benign endometrial polyps: a Dutch survey

et al. 2011

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The purpose of this study is to evaluate the current practice of Dutch gynecologists in the removal of benign endometrial polyps and compare these results with the results of a previous study from 2003. In 2009 Dutch gynecologists were surveyed by a mailed questionnaire about polypectomy. Gynecologists answered questions about their individual performance of polypectomy: setting, form of anesthesia, method, and instrument use. The results were compared with the results from the previous survey. The response rate was 70% (585 of 837 gynecologists). Among the respondents, 455 (78%) stated to remove endometrial polyps themselves. Polyps were mostly removed in an inpatient setting (337; 74%) under general or regional anesthesia (247; 54%) and under direct hysteroscopic vision (411; 91%). Gynecologists working in a teaching hospital removed polyps more often in an outpatient setting compared with gynecologists working in a nonteaching hospital [118 (43%) vs. 35 (19%) p < 0.001]. These results are in accordance with the results from 2003. Compared to 2003 there was an increase in the number of gynecologists performing polypectomies with local or no anesthesia [211 (46%) vs. 98 (22%), p < 0.001]. An increase was also noted in the number of gynecologists using direct hysteroscopic vision [411 (91%) vs. 290 (64%), p < 0.001] and 5 Fr electrosurgical instruments [181 (44%) vs. 56 (19%), p < 0.001]. Compared to the situation in 2003, there is an increase in removal under direct hysteroscopic vision, with 5 Fr electrosurgical instruments, using local or no anesthesia. This implies there is progress in outpatient hysteroscopic polypectomy in the Netherlands.

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Cost-Analysis Comparison of Outpatient See-and-Treat Hysteroscopy Service with Other Hysteroscopy Service Models

Cited by 74 publications

References 24 publications

Endometrial Polyps and Subfertility

Endometrial Polyps and Subfertility

Cost-Effectiveness of Office Hysteroscopy for Abnormal Uterine Bleeding

Current practice in the removal of benign endometrial polyps: a Dutch survey

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