LAUSR

Study Objective To assess the cost-effectiveness of a single-visit uterine assessment and treatment unit (UATU) compared with the current standard of care to diagnose and treat women with abnormal uterine bleeding (AUB). Design A cost-effectiveness analysis using a decision tree model from the perspective of the publicly funded health care system in Canada. Setting An ambulatory women's health clinic at a tertiary academic health sciences center (The Shirley E. Greenberg Women's Health Center at The Ottawa Hospital (TOH)). Patients or Participants Patients presenting with abnormal uterine bleeding. Interventions Non-interventional. Methods We developed a probabilistic decision tree model to simulate the total costs and outcomes of women presenting with AUB receiving diagnosis and treatment at a UATU or usual care over a one-year time horizon. Probabilities, resource use, and time associated with each treatment option were obtained from a retrospective chart review of 200 randomly selected patients presenting with AUB at TOH between April 1st 2014 and March 31st 2017. Results were expressed as overall cost and time savings per patient. A series of sensitivity analyses were conducted to assess the robustness of the study findings. Costs are reported in 2018 Canadian dollars. Measurements and Main Results Compared to usual care, the UATU was associated with a decrease in overall cost ($1,331.90 [95% CI -1,337 to -1,326.8]) and a decrease in overall time to treatment (-74.50 days [95% CI -74.70 to -74.40]), dominating usual care. The point at which the UATU would no longer be cost-effective is if the cost to maintain and operate the UATU required an additional $1,600 spent per patient. The results of the sensitivity analysis did not impact the conclusions from our base-case analysis. Conclusion An outpatient UATU is more cost-effective than usual care and should be recommended as the best use of limited health care resources.