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Peripartum hysterectomy : an economic analysis of direct health care costs using routinely collected data
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Achana, F. A., Fleming, K., Tata, L., Sultan, A. A. and Petrou, S. (2018) Peripartum hysterectomy : an economic analysis of direct health care costs using routinely collected data. BJOG: An International Journal of Obstetrics and Gynaecology, 125 (7). pp. 874-883. doi:10.1111/1471-0528.14950 ISSN 1470-0328.
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Official URL: http://doi.org/10.1111/1471-0528.14950
Abstract
Objective: To estimate resource use and costs associated with peripartum hysterectomy for the English National Health Service.
Design/Settings: Analysis of linked Clinical Practice Research Datalink and Hospital Episodes Statistics (CPRD-HES) data.
Population: Women undergoing peripartum hysterectomy between 1997 and 2013 and matched controls.
Main outcome measures: Primary care, hospital outpatient and inpatient attendances and costs (£, 2015 prices).
Methods: Inverse probability weighted generalised estimating equations were used to model the non-linear trend in healthcare service use and costs over time, accounting for missing data, adjusting for maternal age, body mass index, delivery year, smoking and socio-economic indicators.
Results: The study sample included 1362 women (192 cases and 1170 controls) who gave birth between 1997 and 2013; 1088 (153 cases and 935 controls) of these were deliveries between 2003 and 2013 when all categories of hospital resource use were available. Based on the 2003-2013 delivery cohort, peripartum hysterectomy was associated with a mean adjusted additional total cost of £5,380 (95%CI £4,436 to £6,687) and a cost-ratio of 1.76 (95%CI 1.61 to 1.98) over 5-years of follow-up compared to controls. Inpatient costs, mostly incurred during the first year following surgery, accounted for 78% excluding or 92% including delivery-related costs.
Conclusion: Peripartum hysterectomy is associated with increased healthcare costs driven largely by increased post-surgery hospitalisation rates. To reduce healthcare costs and improve outcomes for women who undergo hysterectomy, interventions that reduce avoidable repeat hospitalisations following surgery such as providing active follow-up, treatment and support in the community should be considered.
Item Type: | Journal Article | ||||||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Journal or Publication Title: | BJOG: An International Journal of Obstetrics and Gynaecology | ||||||||
Publisher: | Blackwell Publishing | ||||||||
ISSN: | 1470-0328 | ||||||||
Official Date: | June 2018 | ||||||||
Dates: |
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Volume: | 125 | ||||||||
Number: | 7 | ||||||||
Page Range: | pp. 874-883 | ||||||||
DOI: | 10.1111/1471-0528.14950 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||||
Date of first compliant deposit: | 27 September 2017 | ||||||||
Date of first compliant Open Access: | 16 November 2018 |
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