Amparo Garcia-Tejedor1, Jose M Martinez-Garcia2, Beatriz Candas3, Elena Suarez4, Laura Mañalich4, Maria Gomez5, Elisabet Merino6, Marta Castellarnau7, Purificacion Regueiro7, Manuel Carreras8, Eva Martinez-Franco8, Marta Carrarrach9, Neus Subirats10, Judith Barbera10, Santiago Gonzalez11, Maite Climent2, Eulalia Fernández-Montolí2, Jordi Ponce2. 1. Departments of Gynaecology (Drs. Garcia-Tejedor, Martinez-Garcia, Climent, Fernández-Montolí, and Ponce), Barcelona. Electronic address: agarciat@bellvitgehospital.cat. 2. Departments of Gynaecology (Drs. Garcia-Tejedor, Martinez-Garcia, Climent, Fernández-Montolí, and Ponce), Barcelona. 3. Biochemistry and Molecular Biology, Clinical Laboratory (Dr. Candas), Barcelona. 4. Hospital Universitari Bellvitge, Hospitalet de Llobregat Idibell, the Department of Gynaecology, Hospital Universitari Vall d'Hebron (Drs. Suarez and Mañalich), Barcelona. 5. Department of Gynaecology, Hospital Universitari Joan XXIII, Tarragona (Dr. Gomez), Barcelona. 6. Department of Gynaecology, Hospital Universitari Doctor Josep Trueta, Girona (Dr. Merino), Barcelona. 7. Department of Gynaecology, Consorci Sanitari Integral, Hospitalet de Llobregat (Drs. Castellarnau and Regueiro), Barcelona. 8. Department of Gynaecology, Hospital de Sant Joan de Déu de Sant Boi, Sant Boi de Llobregat (Drs. Carreras and Martinez-Franco), Barcelona. 9. Department of Gynaecology, Hospital de Viladecans, Viladecans (Dr. Carrarrach), Barcelona. 10. Department of Gynaecology, Hospital Verge de La Cinta, Tortosa, Tarragona (Drs. Subirats and Barbera), Spain. 11. Department of Gynaecology, Hospital de Sant Joan de Déu d'Esplugues, Esplugues de Llobregat, Barcelona (Dr. Gonzalez), Spain.
Abstract
STUDY OBJECTIVE: To compare the cost-effectiveness of ultrasound (US)-guided aspiration and ethanol sclerotherapy versus laparoscopic surgery for benign-appearing ovarian endometrioma. DESIGN: Prospective, cohort pilot study. SETTING: Multiple centers, Spain. PATIENTS: Forty patients with suspected ovarian endometrioma identified by US, with a maximum diameter of 35 to 100 mm, of whom 33 met inclusion criteria. INTERVENTIONS: The study group (n = 17) underwent US-guided aspiration plus sclerotherapy with ethanol, and the control group (n = 14) underwent laparoscopic cystectomy. MEASUREMENTS AND MAIN RESULTS: Recurrence, complications, and direct costs were compared. One of 17 sclerotherapy patients recurred (5.9%) compared with 4 of 14 laparoscopic surgery patients (28.6%) (odds ratio 0.18, 0.01-1.53). No serious adverse effects (Clavien-Dindo ≥ III) were observed in the sclerotherapy group; 1 patient in the surgery group had a Clavien-Dindo IIIb complication. Median hospital direct costs were significantly lower in the sclerotherapy group than those in the surgery group-266 euros versus 2189 euros. CONCLUSION: Ethanol sclerotherapy seems to be cost-effective for endometrioma and also appears to reduce complications. In this pilot study, recurrence was not higher than with conventional surgery.
STUDY OBJECTIVE: To compare the cost-effectiveness of ultrasound (US)-guided aspiration and ethanol sclerotherapy versus laparoscopic surgery for benign-appearing ovarian endometrioma. DESIGN: Prospective, cohort pilot study. SETTING: Multiple centers, Spain. PATIENTS: Forty patients with suspected ovarian endometrioma identified by US, with a maximum diameter of 35 to 100 mm, of whom 33 met inclusion criteria. INTERVENTIONS: The study group (n = 17) underwent US-guided aspiration plus sclerotherapy with ethanol, and the control group (n = 14) underwent laparoscopic cystectomy. MEASUREMENTS AND MAIN RESULTS: Recurrence, complications, and direct costs were compared. One of 17 sclerotherapy patients recurred (5.9%) compared with 4 of 14 laparoscopic surgery patients (28.6%) (odds ratio 0.18, 0.01-1.53). No serious adverse effects (Clavien-Dindo ≥ III) were observed in the sclerotherapy group; 1 patient in the surgery group had a Clavien-Dindo IIIb complication. Median hospital direct costs were significantly lower in the sclerotherapy group than those in the surgery group-266 euros versus 2189 euros. CONCLUSION:Ethanol sclerotherapy seems to be cost-effective for endometrioma and also appears to reduce complications. In this pilot study, recurrence was not higher than with conventional surgery.