Abstract:
:The objective of this study was to assess the cost-effectiveness of hysterectomy performed for benign indications. Hysterectomy remains the most common major gynecological operation in the Western world. Rates of hysterectomy have not declined as expected with the introduction of new treatment options. Furthermore, use of laparoscopic techniques varies widely within the Nordic countries. We designed a systematic review in a University Central Hospital. The sample included all published studies regarding the cost-effectiveness of hysterectomy performed for benign indications (n = 1666). Medline, Cochrane Library, PsycINFO, CINAHL, and Nursing databases were searched. Inclusion criteria were the availability of pre- and post-intervention health-related quality of life measures (HRQoL) and data on costs. HRQoL, costs, and cost-effectiveness of treatment were the main outcome measures. Studies (n = 24) focused on treatment of symptomatic fibroids (n = 8), treatment of heavy menstrual bleeding (n = 10), various surgical techniques (n = 5) and the effect of various indications for hysterectomy (n = 2). Follow-up periods varied from 4 months to over 10 years. SF/RAND-36 or EQ-5D measures and societal cost perspective were most commonly used. Only 11 studies used individual patient data. HRQoL following hysterectomy was generally good but costs were high. The cost-effectiveness depended on indication, age, and duration of follow-up. The cost-effectiveness of hysterectomy has been surprisingly poorly studied. Conclusions are difficult to draw due to different study designs, indications, follow-up times, and HRQoL instruments used. Rates of hysterectomy have declined less than expected with the introduction of new treatment modalities. Costs of surgery are high. Laparoscopic hysterectomy seems to be the least cost-effective, although further data from original patient cohorts with long-term follow-up are needed.
journal_name
Acta Obstet Gynecol Scandjournal_title
Acta obstetricia et gynecologica Scandinavicaauthors
Pynnä K,Vuorela P,Lodenius L,Paavonen J,Roine RP,Räsänen Pdoi
10.1111/aogs.12299subject
Has Abstractpub_date
2014-03-01 00:00:00pages
225-32issue
3eissn
0001-6349issn
1600-0412journal_volume
93pub_type
杂志文章,评审abstract:BACKGROUND:Oxytocics are routinely used in an attempt to prevent excessive blood loss during cesarean section. Misoprostol, a potent uterotonic agent, has been reported to be useful in the prevention and treatment of postpartum hemorrhage by several investigators but its use during cesarean section has not been describ...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1034/j.1600-0412.2001.080003245.x
更新日期:2001-03-01 00:00:00
abstract:BACKGROUND:The increase in the numbers of women fearing childbirth and requesting cesarean sections call for new forms of antenatal treatment. METHODS:Finnish nulliparous women experiencing severe fear of childbirth (experimental group, n = 102) attended 5 group sessions with a psychologist, once together with a midwi...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 临床试验,杂志文章
doi:10.1080/00016340600756920
更新日期:2006-01-01 00:00:00
abstract::A prospective study of the clinical value of the symphysis-fundus (SF) distance was performed on 528 women, all at risk for developing intrauterine growth retardation (IUGR). Four different types of SF curves were observed and denoted as normal, static, catch-up and low. A normal or static SF curve predicted a normal ...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.3109/00016348409155527
更新日期:1984-01-01 00:00:00
abstract:OBJECTIVE:To study whether human chorionic gonadotropin concentrations during pregnancy or combinations of human chorionic gonadotropin and other angiogenic factors, soluble fms-like tyrosine kinase 1 and placental growth factor (PlGF), are associated with preeclampsia risk. DESIGN:Nested case-control study. SETTING:...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.1111/aogs.12363
更新日期:2014-05-01 00:00:00
abstract::We report a case of galactorrhea in a normoprolactinemic fertile woman (30 years old) wearing a copper intra-uterine device (Gravigard). The Gravigard was first inserted in July 1977. In February 1979 our patient noted spontaneous galactorrhea, mainly on the left, but it was also present on the right, after breast pre...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.3109/00016348409156269
更新日期:1984-01-01 00:00:00
abstract::Cesarean hysterectomy is considered the reference standard treatment for placenta accreta. In young women who want the option of future pregnancy and agree to close follow-up monitoring, conservative treatment is a valid option. Several key points of both cesarean hysterectomy and conservative treatment remain debatab...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章,评审
doi:10.1111/aogs.12222
更新日期:2013-10-01 00:00:00
abstract:INTRODUCTION:The impact of placenta previa on pregnancy, delivery and infant outcomes has been extensively studied. However, less is known about the possible association of placental location other than previa with pregnancy outcomes. The aim of this study was to investigate if placental location other than previa is a...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.1111/aogs.13578
更新日期:2019-08-01 00:00:00
abstract::Aortic stenosis (AS) is an uncommon complication during pregnancy, but when it occurs it results in significant maternal and fetal morbidity and mortality. We present a gravida with severe AS in which aortic valve replacement was performed in the 3rd trimester of her pregnancy. She had severe AS with mild aortic regur...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.3109/00016349009028713
更新日期:1990-01-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to evaluate the diagnostic value of transvaginal ultrasound measurement of endometrial thickness, cytology obtained by Gynoscann, and histology of the endometrium sampled by Uterine Explora Curette compared with histology of the uterine specimen as the gold standard. METHODS:Co...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.3109/00016349709024349
更新日期:1997-09-01 00:00:00
abstract::The anti-estrogenic effect of clomiphene citrate (CC) and tamoxifen (TMX) on cervical mucus was evaluated in a prospective crossover study. Ten women underwent randomized alternate cyclical treatment with either 100 mg CC, 40 mg TMX daily, or with placebo. The effect of CC, TMX and placebo on serum estradiol (E2), cer...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1988-01-01 00:00:00
abstract:INTRODUCTION:Pregnancies complicated by chronic hypertension are at increased risk of adverse pregnancy outcomes. To assess whether planned early delivery might prevent some of these adverse outcomes, we studied maternal and neonatal outcomes of pregnancy in women with chronic hypertension, including gestational-age-sp...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.1111/aogs.12757
更新日期:2015-12-01 00:00:00
abstract::A case of traumatic rupture of a normal spleen in a complicated delivery is presented. The etiology of splenic rupture and therapeutic aspects of this unusual occurrence are discussed. It is pointed out that a violent expression of the fetus might be dangerous for the mother. ...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.3109/00016347809155903
更新日期:1978-01-01 00:00:00
abstract:INTRODUCTION:An estimated 2.6 million stillbirths occur worldwide each year. A standardized classification system setting out possible cause of death and contributing factors is useful to help obtain comparative data across different settings. We undertook a systematic review of stillbirth classification systems to hig...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章,评审
doi:10.1111/aogs.13126
更新日期:2017-05-01 00:00:00
abstract:OBJECTIVES:Hysterectomy represents the current routine therapy for high-risk endometrial precancers. More sophisticated methods are needed for treatment decision among women who want to preserve fertility and seriously ill patients. Among women diagnosed with high-risk hyperplasia, approximately 40% show signs of endom...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.3109/00016340903281014
更新日期:2009-01-01 00:00:00
abstract::302 samples from 22 normal pregnancies were frozen and kept for the analysis of free calcium ion concentration [Ca2+](7.4) at 37 degrees C and pH 7.40, after equilibration with CO2. Individual regressions were performed, and the concentration was found to increase slightly but significantly (5%, p less than 0.005) wit...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.3109/00016348109158137
更新日期:1981-01-01 00:00:00
abstract:BACKGROUND:There is a lack of established treatment for Chronic pelvic pain (CPP), defined as acyclic pain of at least six months duration. We decided to study the pain-alleviating effects of stretching on defined structures in women with CPP, and the treatment's impact on quality of life variables. DESIGN OF STUDY:An...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章,随机对照试验
doi:10.1080/00016340500495017
更新日期:2006-01-01 00:00:00
abstract::This paper describes the collection and analysis of data by a group of international collaborators (International Collaborative Effort on Perinatal and Infant Mortality) interested in comparative studies on birthweight distributions and reproductive outcome. This is the first of a series of reports on the results of t...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.3109/00016348909087681
更新日期:1989-01-01 00:00:00
abstract::Heavy menstrual bleedings frequently lead to iron deficiency. Iron supplementation is usually given to cover the increased losses. In the present study one tablet containing 100 mg of iron (Duroferon R, Durules R) was given daily for 10 days in connection with the menstrual period in 15 women with menorrhagia. The tab...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:
更新日期:1981-01-01 00:00:00
abstract::Uterine activity was measured quantitatively during subsequent labor after prostaglandin E2 gel (PGE2). Thirty primigravidae with a low Bishop score were included in this randomized double-blind study. Fewer women who received PGE2 required subsequent surgical induction. The pattern of uterine activity was different. ...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.3109/00016348509154683
更新日期:1985-01-01 00:00:00
abstract:BACKGROUND:Estrogen and progesterone immunoregulate the genital environment by expression of cytokines and growth factors. OBJECTIVE:To investigate the pattern of expression of T-helper cytokines during the ovarian cycle compared with women with chronic anovulation resistant to clomiphene citrate. HYPOTHESIS:Expressi...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.1034/j.1600-0412.2003.00045.x
更新日期:2003-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the cost-effectiveness of a novel intrauterine system, levonorgestrel intrauterine system 13.5 mg vs. oral contraception, in women at risk of unintended pregnancy. DESIGN:Cost-effectiveness model using efficacy and discontinuation data from published articles. SETTING:Societal perspective includ...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.1111/aogs.12679
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:We have reviewed the literature concerning vaginal recurrence in endometrial cancer with emphasis on prognostics and therapeutic results. Compared to the overall outcome of recurrences (11-17 per cent survive more than 3-19 years) the survival rate of strictly vaginal recurrence appears significantly higher ...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章,评审
doi:10.3109/00016349609033275
更新日期:1996-01-01 00:00:00
abstract:OBJECTIVE:To compare the neonatal outcome after a trial of labor (TOL) with that after an elective cesarean section (CS) following one previous cesarean delivery, considering the indication for the first CS. DESIGN:Population-based cohort study. SETTING:Sweden. POPULATION:Women with their first two deliveries betwee...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.1111/aogs.12202
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVE:Hysterectomy may affect bladder and bowel function. A retrospective study was performed to compare the prevalence of micturition and defecation symptoms between different modes of hysterectomy. METHODS:All pre-operatively asymptomatic patients, with uteral size < or =10 cm, who underwent hysterectomy between...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.1034/j.1600-0412.2001.801012.x
更新日期:2001-10-01 00:00:00
abstract::A previously developed mathematical formula for prediction of fetal growth deviation at birth by means of ultrasonic fetometry was applied to 505 unselected singleton pregnancies. The gestational age was assessed by measuring the fetal biparietal diameter (BPD) in the 17th week of pregnancy. In the 33rd and 38th week ...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.3109/00016348309155774
更新日期:1983-01-01 00:00:00
abstract::Three cases of pseudomyxoma peritonei with ovarian neoplasma were treated by adjunctive immunotherapy with OK-432 after surgery. In 2 of the 3 cases, the periods of intramuscular injection of OK-432 were 11 and 16 months, respectively, and the 2 patients remain clinically free from evidence of disease, 7 and 6 years a...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.3109/00016348609158368
更新日期:1986-01-01 00:00:00
abstract:BACKGROUND:Adult granulosa cell tumor of the ovary is an uncommon neoplasm. The overall prognosis is favorable. The prognostic factors that are related to survival have not been well defined and are discussed in the literature amidst controversy. METHODS:Thirty-five patients diagnosed with adult granulosa cell tumor o...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.1080/00016340500324233
更新日期:2006-01-01 00:00:00
abstract::The use of oral contraceptives (OC) has been correlated to several diseases, primarily thromboembolic conditions. Whether these correlations represent a causal relationship or a mere statistical correlation based on other variables, depends on whether users of OC differ in other respects from women in fertile age not ...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.3109/00016348809004163
更新日期:1988-01-01 00:00:00
abstract::A tumor found in endometrial curettings of a 35-year-old woman was originally interpreted as malignant. Review of the slides and additional curettings revealed that the tumor was in reality a plexiform leiomyoma. Attention is drawn to the fact that this rare tumor may be present in endometrial curettings. ...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.3109/00016348609157044
更新日期:1986-01-01 00:00:00
abstract:BACKGROUND:Unexplained antepartum stillbirth is a common cause of perinatal death, and identifying the fetus at risk is a challenge for obstetric practice. Intrauterine growth restriction (IUGR) is associated with a variety of adverse perinatal outcomes, but reports on its impact on unexplained stillbirths by populatio...
journal_title:Acta obstetricia et gynecologica Scandinavica
pub_type: 杂志文章
doi:10.1111/j.0001-6349.2004.00602.x
更新日期:2004-09-01 00:00:00