EP27.03: Cost‐benefit analysis for the utilisation of detailed preoperative ultrasound in women with complex endometriosis disease

About 15% of women who present to a gynecology clinic have chronic pelvic pain (CPP). Up to 26% of this group will have underlying pouch of Douglas obliteration yet 82% of gynecologists admit to not being able to perform advanced laparoscopic surgery. We aim to estimate the costs of a general gynecologist's conventional surgical approach (model 1) vs an ultrasound-based approach (model 2) to women with CPP and complex disease. Model 1: general gynecologist seeing women with suspected endometriosis proceeds directly to diagnostic laparoscopy without an advanced ultrasound examination, finds underlying POD obliteration/complex endometriosis disease and then refers the woman to an advanced laparoscopic surgeon; model 2: general gynecologist orders a detailed ultrasound examination by sonologist with expertise in endometriosis and refer cases with probable POD obliteration/complex endometriosis disease to a skilled advanced laparoscopic surgeon avoiding diagnostic laparoscopy. The costs to the public health system for consultation, ultrasound and various surgical interventions for endometriosis were retrieved from New South Wales Ministry of Health: consultation $A225, detailed ultrasound $A500, diagnostic laparoscopy $A2,541, colonoscopy $A4,880 and laparoscopic bowel surgery $A14,923. Calculations of the cost of treating complex disease were performed and compared for both clinical pathways. For an outpatient gynecology unit that reviews 1000 new consultations annually, 15% (150/1000) women would present with CPP. Of these 26% (39/150) women would have underlying POD obliteration with complex endometriosis. With model 1 the cost of treating each complex case is $A23,970, whereas for model (2) $A21,203. This means that there is a cost saving of $A2767 per case or $A107,913 annually. If a general gynecologist has access to expert ultrasound in the diagnosis of complex endometriosis, this results in significant cost savings to the public healthcare system.