Ambulatory gynaecology: guidelines and economic analysis

Cooper, Natalie Ann MacKinnon (2013). Ambulatory gynaecology: guidelines and economic analysis. University of Birmingham. Ph.D.

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Abstract

The aim of this thesis was to investigate the role of outpatient hysteroscopy in modern gynaecological care by conducting a series of systematic reviews and meta-analyses to examine how the procedure can be optimised to reduce pain and by performing a cost effectiveness analysis.

The systematic reviews concluded that women undergoing outpatient hysteroscopy should take simple analgesia beforehand and that the hysteroscopist should adopt a vaginoscopic approach using a small diameter, rigid hysteroscope and normal saline as the distension medium. If dilatation of the cervix is required this should be done under a paracervical block. These findings were incorporated into a clinical guideline and the quality of the evidence that the reviews provided was assessed using the SIGN and GRADE methods. A comparison of the assessments found that they gave varying estimates of the quality of evidence and that neither offered a perfect solution to the assessment of evidence quality when writing clinical guidance.

The economic analysis found that initial testing with outpatient hysteroscopy was the most cost-effective testing strategy for investigation of heavy menstrual bleeding when compared to other diagnostic tests, regardless of a woman’s wish for future fertility or prior treatment with a levonorgestrel intrauterine system.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):