Health-Related quality of life and cost outcomes of treatment of gynecological conditions

Gynecological disorders are a vast entity consisting of benign and malignant conditions that affect more than half of the global female population. Hundreds of millions of women suffer from physical, sexual and mental symptoms caused by these conditions and need treatment for them in order to preserve their functioning and reasonable quality of life. Gynecological disorders not only affect the lives of the women suffering from them but due to their relatively high prevalence also have a marked impact on the healthcare system, requiring and consuming notable healthcare and economic resources. The aim of this thesis was to gather the previously known information on the cost-effectiveness of benign gynecological treatment (specifically on hysterectomy as the opted therapy) (study I), generate new prospective short- and long-term data on the HRQoL (health-related quality of life) of benign and malignant gynecological patients in a real-life clinical setting by means of the 15D HRQoL questionnaire (studies II and IV) and assess the costs generated in the healthcare system due to these illnesses (studies III-IV). The scarcity of original data and the heterogeneity of studies made it difficult to draw reliable conclusions on the cost-effectiveness of hysterectomy. Other, less invasive treatment options showed to be at least as cost-effective as hysterectomy in treatment of uterine fibroids or heavy menstrual bleeding. Vaginal hysterectomy was reported to be the most cost-effective hysterectomy technique. The age of the patient and the indication of hysterectomy were in association with cost-effectiveness results. Benign gynecological conditions were markedly in association with a broad spectrum of deteriorated HRQoL dimensions (excretion, usual activities, vitality, distress and sexual activity, among others), which remained impaired after treatment. Gynecological bleeding disorders and chronic pelvic pain patients reported poor, and endometriosis and uterine fibroid patients good HRQoL results. Gynecological care of benign disorders caused almost €2,200 of direct hospital costs per patient during a two-year follow-up. Treatment of uterine fibroids and endometriosis was the most expensive. The largest proportion of direct hospital costs was caused by surgery and that of out-of-hospital costs by absence from work. No differences in patient-reported outcomes or costs were seen between smaller community or university hospitals. Gynecological cancer patients reported surprisingly high HRQoL, which was similar to that of the general population. Impaired mental well-being, vitality and sexual activity quickly improved after treatment initiation. Only distress and excretion functions remained impaired in the long run. Gynecological cancer caused direct healthcare costs of over €40,000 per patient during an up to ten-year follow-up.