Safety Warning about Laparoscopic Power Morcellation in Hysterectomy: A Cost-Effectiveness Analysis of National Impact
Background: Following a 2014 safety warning (that laparoscopic power morcellation may increase tumor dissemination if patients have occult uterine cancer), hysterectomy practice shifted from laparoscopic to abdominal approach. This avoided morcellating occult cancer, but increased perioperative comp...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Mary Ann Liebert
2022-03-01
|
| Series: | Women's Health Reports |
| Subjects: | |
| Online Access: | https://www.liebertpub.com/doi/full/10.1089/WHR.2021.0101 |
| _version_ | 1797345784690114560 |
|---|---|
| author | Xiao Xu Vrunda B. Desai Peter E. Schwartz Cary P. Gross Haiqun Lin Maria J. Schymura Jason D. Wright |
| author_facet | Xiao Xu Vrunda B. Desai Peter E. Schwartz Cary P. Gross Haiqun Lin Maria J. Schymura Jason D. Wright |
| author_sort | Xiao Xu |
| collection | DOAJ |
| description | Background: Following a 2014 safety warning (that laparoscopic power morcellation may increase tumor dissemination if patients have occult uterine cancer), hysterectomy practice shifted from laparoscopic to abdominal approach. This avoided morcellating occult cancer, but increased perioperative complications. To inform the national impact of this practice change, we examined the cost-effectiveness of hysterectomy practice in the postwarning period, in comparison to counterfactual hysterectomy practice had there been no morcellation warning.
Materials and Methods: We constructed a decision tree model to simulate relevant outcomes over the lifetime of patients in the national population undergoing hysterectomy for presumed benign indications. The model accounted for both hysterectomy- and occult cancer-related outcomes. Probability-, cost-, and utility weight-related input parameters were derived from analysis of the State Inpatient Databases, State Ambulatory Surgery and Services Databases, data from the New York Statewide Planning and Research Cooperative System and New York State Cancer Registry, and published literature.
Results: With an estimated national sample of 353,567 adult women, base case analysis showed that changes in hysterectomy practice after the morcellation warning led to a net gain of 867.15 quality-adjusted life years (QALYs), but an increase of $19.54 million in costs (incremental cost-effectiveness ratio?=?$22,537/QALY). In probabilistic sensitivity analysis, the practice changes were cost-effective in 54.0% of the simulations when evaluated at a threshold of $50,000/QALY, which increased to 70.9% when evaluated at a threshold of $200,000/QALY.
Conclusion: Hysterectomy practice changes induced by the morcellation warning are expected to be cost-effective, but uncertainty in parameter values may affect the cost-effectiveness results. |
| first_indexed | 2024-03-08T11:22:33Z |
| format | Article |
| id | doaj.art-7c701afd5bc64f4f8a6ee3e0e1ab75f8 |
| institution | Directory Open Access Journal |
| issn | 2688-4844 |
| language | English |
| last_indexed | 2024-03-08T11:22:33Z |
| publishDate | 2022-03-01 |
| publisher | Mary Ann Liebert |
| record_format | Article |
| series | Women's Health Reports |
| spelling | doaj.art-7c701afd5bc64f4f8a6ee3e0e1ab75f82024-01-26T05:55:08ZengMary Ann LiebertWomen's Health Reports2688-48442022-03-013136938410.1089/WHR.2021.0101Safety Warning about Laparoscopic Power Morcellation in Hysterectomy: A Cost-Effectiveness Analysis of National ImpactXiao XuVrunda B. DesaiPeter E. SchwartzCary P. GrossHaiqun LinMaria J. SchymuraJason D. WrightBackground: Following a 2014 safety warning (that laparoscopic power morcellation may increase tumor dissemination if patients have occult uterine cancer), hysterectomy practice shifted from laparoscopic to abdominal approach. This avoided morcellating occult cancer, but increased perioperative complications. To inform the national impact of this practice change, we examined the cost-effectiveness of hysterectomy practice in the postwarning period, in comparison to counterfactual hysterectomy practice had there been no morcellation warning. Materials and Methods: We constructed a decision tree model to simulate relevant outcomes over the lifetime of patients in the national population undergoing hysterectomy for presumed benign indications. The model accounted for both hysterectomy- and occult cancer-related outcomes. Probability-, cost-, and utility weight-related input parameters were derived from analysis of the State Inpatient Databases, State Ambulatory Surgery and Services Databases, data from the New York Statewide Planning and Research Cooperative System and New York State Cancer Registry, and published literature. Results: With an estimated national sample of 353,567 adult women, base case analysis showed that changes in hysterectomy practice after the morcellation warning led to a net gain of 867.15 quality-adjusted life years (QALYs), but an increase of $19.54 million in costs (incremental cost-effectiveness ratio?=?$22,537/QALY). In probabilistic sensitivity analysis, the practice changes were cost-effective in 54.0% of the simulations when evaluated at a threshold of $50,000/QALY, which increased to 70.9% when evaluated at a threshold of $200,000/QALY. Conclusion: Hysterectomy practice changes induced by the morcellation warning are expected to be cost-effective, but uncertainty in parameter values may affect the cost-effectiveness results.https://www.liebertpub.com/doi/full/10.1089/WHR.2021.0101laparoscopic power morcellationhysterectomyoccult uterine cancercomplicationscost-effectiveness |
| spellingShingle | Xiao Xu Vrunda B. Desai Peter E. Schwartz Cary P. Gross Haiqun Lin Maria J. Schymura Jason D. Wright Safety Warning about Laparoscopic Power Morcellation in Hysterectomy: A Cost-Effectiveness Analysis of National Impact Women's Health Reports laparoscopic power morcellation hysterectomy occult uterine cancer complications cost-effectiveness |
| title | Safety Warning about Laparoscopic Power Morcellation in Hysterectomy: A Cost-Effectiveness Analysis of National Impact |
| title_full | Safety Warning about Laparoscopic Power Morcellation in Hysterectomy: A Cost-Effectiveness Analysis of National Impact |
| title_fullStr | Safety Warning about Laparoscopic Power Morcellation in Hysterectomy: A Cost-Effectiveness Analysis of National Impact |
| title_full_unstemmed | Safety Warning about Laparoscopic Power Morcellation in Hysterectomy: A Cost-Effectiveness Analysis of National Impact |
| title_short | Safety Warning about Laparoscopic Power Morcellation in Hysterectomy: A Cost-Effectiveness Analysis of National Impact |
| title_sort | safety warning about laparoscopic power morcellation in hysterectomy a cost effectiveness analysis of national impact |
| topic | laparoscopic power morcellation hysterectomy occult uterine cancer complications cost-effectiveness |
| url | https://www.liebertpub.com/doi/full/10.1089/WHR.2021.0101 |
| work_keys_str_mv | AT xiaoxu safetywarningaboutlaparoscopicpowermorcellationinhysterectomyacosteffectivenessanalysisofnationalimpact AT vrundabdesai safetywarningaboutlaparoscopicpowermorcellationinhysterectomyacosteffectivenessanalysisofnationalimpact AT petereschwartz safetywarningaboutlaparoscopicpowermorcellationinhysterectomyacosteffectivenessanalysisofnationalimpact AT carypgross safetywarningaboutlaparoscopicpowermorcellationinhysterectomyacosteffectivenessanalysisofnationalimpact AT haiqunlin safetywarningaboutlaparoscopicpowermorcellationinhysterectomyacosteffectivenessanalysisofnationalimpact AT mariajschymura safetywarningaboutlaparoscopicpowermorcellationinhysterectomyacosteffectivenessanalysisofnationalimpact AT jasondwright safetywarningaboutlaparoscopicpowermorcellationinhysterectomyacosteffectivenessanalysisofnationalimpact |