Cost Analysis of Vaginal Hysterectomy as Compared to Laparoscopic Assisted Vaginal Hysterectomy for Non-prolapse Uterus in a Tertiary Institution in South Africa

Abstract

Background: Many hysterectomies are now performed by laparoscopic assisted vaginal hysterectomy (LAVH) technique. To establish LAVH as a routine procedure remains controversial, partly because of concerns about the cost. We studied hospital charges and cost of LAVH as compared to vaginal hysterectomy (VH) for non-prolapse uterus in clinically similar groups of patients. Study design: This was a cross-sectional analytic study, covering a period of two years. This study was undertaken at the Department of Obstetrics and Gynaecology of the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), to determine the direct hospital costs between the two surgical techniques VH and LAVH respectively. Women admitted for hysterectomy for benign uterine conditions, were enrolled in the study. Criteria for inclusion were uterine size less than 12 weeks gestation, width ≤ 9 cm and length ≤ 14 cm on ultrasound examination. Clinical ovarian pathology and uterine prolapse were criteria for exclusion. Patients were recruited from the unit records and divided into two groups matched with respect to age, parity, and indications for hysterectomy. Vaginal hysterectomy was performed in 60 patients out of the 100 patients included in the study, and 40 patients underwent LAVH. Results: All cases were successfully performed with no need to convert to the abdominal route. The time required for LAVH was significantly longer as compared to VH: 64, 0 v 31,3 minutes respectively (p<0.001). The postoperative hospital stay days and opiate injections required were both not significantly different between the VH and LAVH groups. Longer operating time and, as well as the expenses of the equipment to perform LAVH, were the main sources of additional cost in LAVH. The average hospital charges were significantly higher in LAVH as compared to VH (p<0.001). Conclusion: Both techniques offer the same benefits of shorter hospital stay, less analgesia needed, rapid mobilisation, and early discharge. However, VH was found to be least costly, mainly due to significant less operative time. LAVH is significantly costlier, mainly due to expensive laparoscopic devices and afore-mentioned long operation time.