BOOKS OF RtfiDIfGS - PAHO/WHO

I,,qr *ir 'ilu.,i XV. Seplteri¡br 1978
- 395 -
year-old woman is justified on the basis of
known risks and benefits." Deane and Ulene'
compared hystereclomy and tubal ligalion as
alternative sterilizaltion strategies in )oung
women who desired permanent contraception.
Using decision analysis and cost-benefit analyi,.
they found thal al interest rates atove
5/r. tubal ligation would be the preferred stralegy
for all women over 20 years old. since il
would be less cosily in both mortality and dollar
dimensions. Cole and Berlin" examined the
benefis and cosIs of elective hysterectomy for
women at age 35 years. Assuming a 0.06r'/
operative mortality rate and using rlhorecical
cosi projections. the) concluded thal the opcration
would increase life expectancy by 0.2
years and Ihal ihe cosl of performing ihe operalion
on one million women would exceed
the benefil by $570 million when discounted
to present value. They concluded that can.
prophylaxis was not adequate justificaiion f.
elective hysterectomy.
Olher siudies have documented the adverse
psychological sequelae' ° " ' thal may befall
women undert .-,-,. .- sl:rectomy;: arker':'
iuggested that the-;e were more likely lo be
fomund in a woman in whom ihe procedure had
been eleclive. The consensus of current literature
concerning intangible considcralions favorn
he notion that the cosis lo a woman of
having an eleclive hysiereciomy outweigh thc
benefils.
Marib and Methods
Data for the study were obtained from the Seattle
Prepaid Health Care Project"' a fouryear
wcial experiment designed lo evaluate
the effect of provider financing and organization
on patienl health status and utilization of
medical services. Near-pIoor families residing
in the Model Cilies larget arca of Seattle who
met pecific income requircmcnt% were Clig,.
ble lor the Project. The charge data (amount%
paid io providers) were collected on paticnt%
enrolled in a very comprehensive prcpaymcnt
plan thai full) covered all medict:l servicc%
provided by membcrs if a Physicians' Service
Bureau (Kng C'ounty Med":aL'Blue Shieid)
and community hospita.is The providers in.
Cludedl alI couínunity hospital., pharmace%.
and virtuall) all non-federal. n)n-.goup health
coopcralive pihysiicians in King ('ouniv.
WashingIon. There were no deductibles or
other copayments. For ¡he services considered
in this paper. and within the time period
examined. information on amounts paid lo
providers for inpatient and ambulatory medical
services is essentially complete.
The data base consisted of all paid charges
thal occurred due lo the specified uterine-related
gynecologic diseases listed in Table 1.
These data were collecied by selecting information
using three-digit diagnosis codes from
ihe EiKghh Revi.sion. Internarional Clussificarion
of Dise.ses. ' Some overlap occurred in
the diagnoses between conditions which could
be attribuied lo an intact uterus and ihose
which would nol occur afler hysterectonmy.
The categories included in the list are those
w here vinually all of the cases could hbe ashted
lo be attributable lo the presence of an
nltact uterus. If most of the diagnoses in a
d .gory could occur in a woman posthyster-
.omy. this calegory was excluded. In this
--. ¡. the charge data served as an estimate of
ihe to,.' cosl of gynecologic services consumed
because of uterine-relaled disease. In
women who have had a hysterectorny.
charges for none of ihese diagnoses should be
incurred. and those foregone charges therefore
would be considered tangible benefits,, of
surgery.
Table 1. Uterine-related diagoses used for
dala s~let'ion
tH I('I)A
MalqnJan neop1am, uihc r ervxu U4t)
Maiarnaln neoplasms ol ihe uiteus I.2
Utenine fibrona t I«
¢(her beni#n ncuplam% fd ihc uierus '19
Ncu0plkm% uniptc'ised >< the uicru, 214
Irun d