Health-economic Analysis For Different Routes Of Hysterectomy For Myoma

Background: Hysterectomy is one of the normal gynecologicsurgeries.Myoma is a main indication of hysterectomy.There are differentkinds of hysterectomy,the traditional ones are transabdominalhysterectomy and transvaginal hysteredtomy.With the development ofminimally invasive concept and laparoscopic technique, total laparoscopichysteredtomy came into being. Every method has its ownadvantages,physicians should make a decision on the characteristics of thediease,the condition of the patient and the experence of the doctor.When apatient is suit for three routes,the ecnomic input becomes an importantfactor to chose the method.Now peple and essays discuss the clinic effectmainly,the health-economic analysis is rather few. Health-economy is anew branch of economy, a subject that study the interrelated and interactof the health care,health of people and development of the social andeconomy. Health-economy’s genesis and development have closeconnections with policy,economy,population,health and so on.With thesocial glooming, health-economy has playing an more and moresignificant role. Health-economic references the rules and motheds ofrandomized controlled trials system evaluation and collates all relevanteconomic studies of some interventions aiming at one disease to analysis the difference of distinct health-economy results and offer an evidence foroverall analysis. Value-base medicine is a clinic idea in practise whichcomplise with the reformation of the medical model and based on theevidence based medicine, and it combines the value of life which isexpexted by patients and the medical cost. Value-base medicine emphasizethe individuals and value the will of the patient.The decision based on itwill be more scientific and reflects the people-oriented concept. Whatvalue-base medicine and health-economic analysis study are supply toeach other.they both discuss how to use the lowest cost to get a bettermedical profits.We analysis the meical cost,cost make-up andcost-effectiveness evaluation to offer an way to chose best surgery methodin health-economic analysis area in order to optimize allocation ofresoures. Aim:Do health-economic analysis for differernt routes ofhysterectomy for myoma in order to offer a way to chose the best surgeryin health-economy view and maximize the best ues of healthcarefunds.Materials and Methods:1.Object of StudyCollect176patients withmyoma from2012.1to2013.1in2nd Hospital of Jilin University,82ofwhom undergone TAH,42of whom undergone TVH and52undergoneTLH.All of them have the indication of hysteredtomy.2.MethodsAnesthesia:spinal-epidural anesthesia on TAH,epidural anesthesia oron spinal-epidural anesthesia on TVH,general anesthesia on TLH. Operation: TAH and TVH are both done by routine,as for TLH,allprocedures are done under laparoscope and we take the total uterusthrough vagina.3.Computing method3.1costing method:every patient’s cost include the followings:（1）Directcost:medical cost,operation cost,medicine cost and other cost included;（2）:Indirect cost:food cost,transport expense,nursing cost and lostincome included;（3）：Total cost:is the sum of direct cost and indirectcost.Lost income is the days of lost labor*the average daily income,thecitizen average annual income of Jilin province based on Jiiln statisticalbureau is20208yuan in2012,so the average daily income is20208/365=55.36yuan,nursing cost is230per day.3.2cost proportion:every kind of cost’rate of the total cost.3.3clinic effective index:take a turn for the better is identified as nocomplications in or after the operation,so the rate is the number of turnbetter÷the total number of the operation*100%.3.4cost-effectiveness evaluation:we take the equivalent effectivenessevaluation,it is the comparison of the least average cost juding by theclinic effect,which means:the cost of a better turn is the total cost of aoperation/the rate of better turn*the number of the total patients4.Statistical treatment:We use software SPSS20.0to do statistics,and use t test and Mann-Whitney U to correct,and square test to test rate. p<0.05shows thesignificont difference.Result:This essay ues days in hospital,medical cost,medicine cost,operationcost,other cost(medical cost minus medicine cost and operation cost),totalindirect cost and total cost as the observing index.We compare every twogroups. TAH compares with TLH,medical cost,medicine cost,operationcost,other cost and total cost are lower, p<0.05. TAH compares with TVH,medicine cost,operation cost are lower,but other cost is higher, p<0.05.TLH compares with TVH, medical cost, operation cost, other cost andtotal cost are higher, p<0.05.there are no significant difference above thegroups, p>0.05.Cost proportion is other cost> medicine cost>operationcost> total indirect cost. TAH the better turn rate is98.8%, TLH is90.1%，TVH is95.2%， p>0.05.Cost-effectiveness evaluation, TAH is11815.43yuan，TLH is16937.882yuan，TVH is12770.85yuan，TVH isthe best.Conclusion:TAH is the most traditional way and can be used on all thepatients,especially the ones who have adhesion in plevic,who haveundergone operations and when the operation is hard to go on.But itsdisadvantages are a greater loss of blood,much pain after the operation,aslow recovery and a big scar.TVH’s indications are uterus which is smallerthan a18-week pragnancy uterus and lighter than600g.It has small influnce in the organs in the enterocoelia,and a quick recovery and there isno scar.But the vision is smaller and can be undergone when a severadhesion in plevic excits.TLH usually doesn’t adopted in the situationsthat a big uterus (larger than20-week pragnancy uterus), sever adhesionin plevic,a close of the rectouterine pouch and prolapse of uterus.But it canenlarge the vision of anatomy,patients recovery fast and there is small scarWhen the three routes can be undergone on one patient,TAH is the bestfrom the view of effect,TLH costs the most and TVH has the bestcost-efficiency analysis from the health-economic analysis.TVH has asmaller injury,a fast recovery and no scars,so TVH is the best choice forhysterectomy.Though TVH has a worse cost-efficiency analysis,but it alsohas a smaller injury,a fast recovery and it can enlarge the vision torecognise the structures ect.With the improvement of physicians’experence and skills,the laproscope has a great space to improve. 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