{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T01:50:25Z","timestamp":1764640225708,"version":"3.46.0"},"reference-count":38,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:00:00Z","timestamp":1760745600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["843002603"],"award-info":[{"award-number":["843002603"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Hysteroscopic myomectomy is the first\u2010choice treatment for symptomatic type 0 and 1 fibroids and was traditionally performed under general anesthesia. Over the last decade, surgical procedures have increasingly been performed in an outpatient setting under procedural sedation and analgesia. However, studies evaluating the safety and cost\u2010effectiveness of hysteroscopic myomectomy under procedural sedation and analgesia are lacking. This study aimed to assess the cost\u2010effectiveness of procedural sedation and analgesia with propofol in an outpatient setting for hysteroscopic myomectomy compared to general anesthesia in an operating room.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>\n                      This was a cost\u2010effectiveness analysis from a societal perspective alongside a multicenter randomized controlled non\u2010inferiority trial. It was conducted in 14 Dutch university and teaching hospitals. Women aged \u226518\u2009years with symptomatic type 0\/1 fibroids (maximum number 3, maximum diameter 3.5\u2009cm), sufficient knowledge of Dutch\/English, and American Society of Anesthesiologists class 1\/2 were included. A total of 209 women were randomized to hysteroscopic myomectomy with procedural sedation and analgesia in an outpatient setting (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009106) or general anesthesia in an operating room (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009103). The primary outcome of the clinical trial was the percentage of complete resections measured by transvaginal ultrasonography 6\u2009weeks postoperatively (non\u2010inferiority margin 7.5% of incomplete resections). Societal costs and quality\u2010adjusted life years (QALYs) were assessed. Societal costs were related to the percentage of complete resections and QALYs. Incremental Cost\u2010Effectiveness Ratios (ICERs) were calculated. Uncertainty surrounding these was estimated using bootstrapping. Follow\u2010up period was 12\u2009months. Dutch Trial Register NTR 5357.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Hysteroscopic resection was complete in 86\/98 women (87.8%) with procedural sedation and analgesia and 79\/89 women (88.8%) with general anesthesia, mean difference \u22120.0052 (95% CI \u22120.097 to 0.086). Non\u2010inferiority could not be demonstrated. There was a statistically significant difference in costs between procedural sedation and analgesia and general anesthesia (\u20ac\u22122577, 95% CI \u22123950 to \u22121157), but not in QALYs (0.011, 95% CI \u22120.019 to 0.040). The ICER per additional complete resection was \u20ac498\u2009797 and for QALYs the ICER showed that procedural sedation and analgesia was dominant over general anesthesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this study, procedural sedation and analgesia for hysteroscopic myomectomy in an outpatient setting is cost\u2010effective compared to general anesthesia in an operating room, although non\u2010inferiority for complete resections could not be demonstrated. We therefore suggest the outpatient use of procedural sedation and analgesia for hysteroscopic myomectomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.70053","type":"journal-article","created":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T22:13:31Z","timestamp":1760825611000},"page":"2320-2330","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Procedural sedation and analgesia versus general anesthesia for hysteroscopic myomectomy: A cost\u2010effectiveness analysis alongside a randomized controlled trial"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9483-146X","authenticated-orcid":false,"given":"Julia F.","family":"van der Meulen","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology M\u00e1xima Medical Centre  Veldhoven The Netherlands"},{"name":"Grow School for Oncology and Reproduction Maastricht University  Maastricht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"El Alili","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Faculty of Science Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sjors F. 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J.","family":"Coppus","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology M\u00e1xima Medical Centre  Veldhoven The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen S.","family":"Kok","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Alrijne Ziekenhuis  Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0104-6751","authenticated-orcid":false,"given":"Jaklien C.","family":"Leemans","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology M\u00e1xima Medical Centre  Veldhoven The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marlies Y.","family":"Bongers","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology M\u00e1xima Medical Centre  Veldhoven The Netherlands"},{"name":"Grow School for Oncology and Reproduction Maastricht University  Maastricht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judith E.","family":"Bosmans","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Faculty of Science Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,18]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.99"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6874-12-6"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.12.002"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmm041"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/17.9.2435"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1074-3804(05)60012-6"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2010.03.014"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2004.00064.x"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13434"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7230.279"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h1398"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(98)70216-1"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200204000-00031"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2023.05.035"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1004323"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-019-0742-1"},{"key":"e_1_2_13_18_1","unstructured":"Kwaliteitsinstituut voor de Gezondheidszorg CBO.PSA bij volwassenen op locaties buiten de OK. 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