Cost-Effectiveness of Combined Minimally Invasive Hysterectomy and Bariatric Surgery in Women With Morbid Obesity and Endometrial Hyperplasia or Early-Stage Endometrial Cancer

Study Objective: We studied the cost-effectiveness of simultaneous bariatric surgery and minimally invasive hysterectomy (MIH) (combined surgery) in comparison to MIH alone in endometrial cancer (EC) survivors with obesity-related disease (ORD). Design: Cost-effectiveness analysis. Setting: Hypothetical cohort of women aged 50 to 69 with obesity (BMI ≥ 30 kg/m²) and ORD (hypertension, diabetes, coronary heart disease, or stroke) undergoing surgery for endometrial intraepithelial neoplasia or early-stage EC. Interventions: Combined surgery vs MIH alone. Measurements and Main Results: We constructed a decision-analytic model with lifetime horizon to compare life expectancy and lifetime healthcare costs between patients with combined surgery and those with MIH alone. Utility weights, a measure of health states that affect quality of life, from published studies were used to calculate quality-adjusted life years (QALYs). Lifetime healthcare costs associated with ORD and costs for MIH and surgical complications were obtained from published studies. Costs for combined surgery were obtained from a single institution. All costs were evaluated from the healthcare sector perspective and presented in US dollars at the 2022 price level. Future costs and QALYs were discounted to present values using an annual rate of 3%. For the 50 to 59 age group, QALYs for combined surgery were 14.8 compared with 11.0 for MIH alone. The lifetime healthcare cost for patients with combined surgery was $186 124 compared with $335 995 for MIH alone. For the 60 to 69 age group, QALYs for combined surgery were 12.0 compared with 7.9 for MIH alone. The lifetime healthcare cost for patients with combined surgery was $155 451 compared with $273 403 for MIH alone. Combined surgery yielded higher QALYs and lower costs than MIH alone. Conclusion: For women with endometrial intraepithelial neoplasia or early-stage EC with obesity and ORD, combined surgery may represent a cost-saving and QALYs-improving option for treatment. However, barriers to this approach may be insurmountable.