OBJECTIVES: A hysterectomy is the surgical removal of the uterus, and most likely, the cervix, with four possible surgical approaches for benign disease: abdominal (AH), laparoscopic (LH), vaginal (VH), and robotic-assisted hysterectomy (not assessed). This analysis aims to estimate the budget impact of increasing minimally invasive surgical approaches to hysterectomy for women with benign gynaecological conditions [LH and VH with/without bipolar vessel sealing (BVS) as a haemostatic control method] against AH from a Spanish, tertiary hospital perspective.

METHODS: A cost analysis was developed based on previously published data assessing different surgical approaches for benign hysterectomy and endorsed by a clinical expert. Unit costs, obtained from different Spanish sources and expressed in €2022, were applied to health resource consumption comprising the preoperative hospitalization, the surgical procedure, the postoperative hospitalization and complications related to surgical approach up to 1 year. The base case, considering the hospital’s surgical case-mix (20.0% AH, 50.0% LH and 30.0% VH), was compared with a desirable scenario with higher rates of minimally invasive procedures (10.0% AH, 52.5% LH and 37.5% VH with BVS). An alternative scenario, representative of the Spanish landscape, was also assessed. Deterministic sensitivity analysis was performed to assess the robustness of the results.

RESULTS: Estimated mean total costs per patient undergoing AH, LH, VH and VH-BVS were €4,902.0, €4,300.7, €3,086.7, and €2,203.1, respectively. Comparing current against desirable hospital’s surgical case-mix scenarios resulted in mean total cost savings of €482.5 per patient. Costs associated with the preoperative hospitalization, surgical procedure, postoperative hospitalization and complications decreased €3.6 (17.0%), €186.7 (11.4%), €187.9 (12.1%) and €104.4 (12.4%), respectively. As per the sensitivity analysis, overall mean costs were more sensitive to changes in the operating room unit cost.

CONCLUSIONS: Efforts to increase minimally invasive techniques to improve the care of women with benign gynaecological conditions could yield relevant savings in Spain.