Delivering an effective outpatient service in gynaecology

A randomised controlled trial analysing the cost of outpatient versus daycase hysteroscopy

Objective  To examine the cost implications of outpatient versus daycase hysteroscopy to the National Health Service, the patient and their employer.

Design and interventions  Randomised controlled trial.

Setting  The gynaecology clinic of a large teaching hospital.

Participants  Ninety-seven women with abnormal uterine bleeding requiring investigation.

Methods  Women were randomly allocated to either outpatient or daycase hysteroscopy. They were asked to complete diaries recording expenses and time off work. The National Health Service costs were calculated for a standard outpatient and daycase hysteroscopy.

Main outcome measures  Costs to the National Health Service, costs to the employer, loss of income, childcare costs and travel expenses.

Results  The outpatient group required significantly less time off work compared with the daycase group (0.8 days vs 3.3 days), P < 0.001. Of those women who lost income due to the hysteroscopy, the average loss of income was twice as much in the daycase group (£20.40 in the outpatient group vs£50.60 in the daycase group). The average cost of childcare required to cover the time spent in hospital undergoing the hysteroscopy was similar in both groups, however, the number of women requiring childcare was small. Travel costs incurred by the women were 74% more in the daycase group compared with the outpatient group—with an average cost of £3.46 in the outpatient group and £6.02 in the daycase group. Daycase hysteroscopy costs the National Health Service approximately £53.88 more per patient, than performing an outpatient hysteroscopy. Purchasing the hysteroscopes necessary to perform an outpatient hysteroscopy is a more expensive outlay than those required for daycase hysteroscopy. However, there are so many other savings that only 38 patients need to undergo outpatient hysteroscopy (even with a 4% failure rate) rather than daycase hysteroscopy in order to recoup the extra money required to set up an outpatient hysteroscopy service.

Conclusion  Outpatient hysteroscopy offers many benefits over its traditional counterpart including faster recovery, less time away from work and home and cost savings to the woman and her employer and the National Health Service. Resources need to be made available to rapidly develop this service across the UK in order to better serve both patient and taxpayer.