Endometriosis cost-effectiveness of therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Joseph Nasr, M.D.[2]
Overview
Formal cost-effectiveness analyses of endometriosis therapies are limited.
However, evidence-based management strategies may reduce recurrence, repeat surgery, and long-term morbidity, which may have indirect economic implications.[1][2][3]
Cost-Effective Considerations
- Cost-effectiveness analyses specific to endometriosis therapies are not well established.
- Guideline-supported presumed diagnosis based on symptoms and imaging may reduce unnecessary diagnostic laparoscopy and associated healthcare utilization.[4][5]
- Postoperative hormonal suppression reduces recurrence (10.7% vs 26.4%; RR 0.41, 95% CI 0.26–0.65), which may decrease need for repeat surgical intervention.[2]
- Repeated surgical procedures should be avoided when possible due to limited evidence of long-term benefit and associated morbidity.[3]
- Ovarian conservation during hysterectomy, when appropriate, may reduce long-term cardiovascular, metabolic, and mental health risks associated with surgical menopause.[6][7][8]
References
- ↑ Singh SS, Allaire C, Al-Nourhji O, et al. Guideline No. 449: diagnosis and impact of endometriosis—a canadian guideline. J Obstet Gynaecol Can. 2024; 46(5):102450. doi:10.1016/j.jogc.2024.102450
- ↑ 2.0 2.1 Zakhari A, Delpero E, McKeown S, Tomlinson G, Bougie O, Murji A. Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis. Hum Reprod Update. 2021;27(1):96-107. doi:10.1093/humupd/ dmaa033
- ↑ 3.0 3.1 Fang QY, Campbell N, Mooney SS, Holdsworth-Carson SJ, Tyson K. Evidence for the role of multidisciplinary team care in people with pelvic pain and endometriosis: a systematic review. Aust N Z J Obstet Gynaecol. 2023;64(3):181-192. doi:10.1111/ajo.13755
- ↑ Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Australian Clinical Practice Guideline for the Diagnosis and Management of Endometriosis. Royal Australian and New Zealand College of Obstetricians and Gynaecologists; 2021. Accessed February 10, 2025. https://ranzcog.edu.au/wp-content/uploads/+2022/02/Endometriosis-clinical-practice-guideline.+pdf
- ↑ National Institute for Health and Care Excellence. Endometriosis: Diagnosis and Management: NICE Guideline 37. Published September 6, 2017. Updated April 16, 2024. Accessed January 13, 2025. https://www.nice.org.+uk/guidance/ng73/evidence/full-guideline-pdf-+4550371315
- ↑ Honigberg MC, Zekavat SM, Aragam K, et al. Association of premature natural and surgical menopause with incident cardiovascular disease. JAMA. 2019;322(24):2411-2421. doi:10.1001/jama. 2019.19191
- ↑ Laughlin-Tommaso SK, Khan Z,Weaver AL, Smith CY, RoccaWA, Stewart EA. Cardiovascular and metabolic morbidity after hysterectomy with ovarian conservation: a cohort study. Menopause. 2018;25(5):483-492. doi:10.1097/GME. 0000000000001043
- ↑ Laughlin-Tommaso SK, Satish A, Khan Z, Smith CY, RoccaWA, Stewart EA. Long-term risk of de novo mental health conditions after hysterectomy with ovarian conservation: a cohort study. Menopause. 2020;27(1):33-42. doi:10.1097/GME. 0000000000001415