OBJECTIVES: Hysteroscopic resection represents the standard treatment for endometrial polyps, a common condition diagnosed in 10%-40% of women with abnormal uterine bleeding, as well as in 1%-12% of asymptomatic patients. The procedure can be performed in the operating room; however, technological advancements, such as hysteroscopic morcellation, have enabled the performance of polypectomy in the office setting. This analysis sought to explore the economic implications associated with the introduction of in-office hysteroscopic morcellation (IO-HM) versus hysteroscopic resection with a conventional resectoscope in the operating room (OR-CR) for the treatment of endometrial polyps, from a Spanish hospital perspective.

METHODS: A cost analysis was developed based on previously published evidence on health resource use (HRU) for in-office and operating room hysteroscopic resection of endometrial polyps, endorsed by a clinical expert. Unit costs, obtained from Spanish sources and expressed in €2024, were applied to estimates of HRU comprising the preanesthetic assessment, surgical procedure and postoperative recovery room stay. The budget impact over a 3-year time horizon, in a hypothetical cohort of 250 patients annually treated and a progressive implementation rate of IO-HM (25%, 50% and 75% the first, second and third year, respectively), and the number of operating room hours released, were also estimated.

RESULTS: Estimated mean total costs were €681.4 and €986.8 per patient undergoing IO-HM and OR-CR, respectively. In comparison to OR-CR, the introduction of IO-HM would result in mean total cost savings of €305.4 per patient, attributed to similar surgical procedure costs (€681.4 IO-HM vs. €671.3 OR-CR), along with the elimination of preanesthetic assessment (-€209.5) and postoperative recovery room stay requirements (-€106.0). Over 3 years, total savings associated with the progressive implementation of IO-HM were estimated at €114,528.6 and 352.5 operating room hours would be released.

CONCLUSIONS: The implementation of IO-HM for treating endometrial polyps could yield substantial cost savings in Spain.