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We have conducted a rapid health technology assessment of hysterectomy (surgical removal of the uterus) for heavy menstrual bleeding on behalf of the Commissioning Forum Regional Health Authority. This is a pilot in a project on reassessment led by the Central Norway Regional Health Authority. We have extracted results on efficacy and safety and assessments of certainty in the evidence on efficacy from a report by the National Institute for Health and Care Excellence, and conducted a cost analysis. The results must be interpreted in context with other factors that influence treatment choice, and that usual practice should include trying less invasive alternatives first.
- Low to very low-certainty evidence suggests that there is little or no difference between hysterectomy and uterine artery embolization in health-related quality of life and patient satisfaction in women with fibroids
- The evidence (certainty not assessed) suggests that hysterectomy results in similar or higher health-related quality of life and patient satisfaction compared with levonorgestrel-releasing intrauterine system, and first- and second-generation resection/ablation in women with no identified pathology
- Hysterectomy may give more serious complications than the alternatives, but small randomized controlled trials are not well suited to assess adverse events
- Hysterectomy and uterine artery embolization are the most costly treatments, mostly due to hospital admission. These cost around 72 000 and 91 000 Norwegian krone. Endometrial resection/ablation and transcervical resection of fibroids cost about 25 000 and 27 000 Norwegian krone. Intrauterine devices are very inexpensive and are already usually used as first choice treatment. For the treatments other than hysterectomy there is a risk of need for a new treatment in case of unsatisfactory effect