Understanding the Vermicompost Process in Sewage Sludge: A Humic Fraction Study

Abstract

STUDY OBJECTIVE: To compare the institutional cost of permanent female sterilization by Essure hysteroscopic sterilization and laparoscopic bilateral coagulation. DESIGN: Retrospective cohort study (Canadian Task Force classification II-2). SETTING: Midwestern academic medical center. PATIENTS: Women of reproductive age who elected for permanent contraception by the Essure method (n = 43) or by laparoscopic tubal coagulation (n = 44) during the time frame studied. INTERVENTIONS: Placement of the Essure inserts according to the manufacturer's instructions or laparoscopic tubal sterilization using bipolar forceps according to standard techniques of open or closed laparoscopy. MEASUREMENTS AND MAIN RESULTS: Cost-center data for the institutional cost of the procedure was abstracted for each patient included in the study. In addition, demographic data and procedural information were obtained and compared for the patient populations. The Essure system of hysteroscopic sterilization had a significantly decreased cost compared with laparoscopic tubal sterilization when both procedures were performed in an operating room setting. The decrease per patient in institutional cost was $180 (p = .038). This included the cost of the confirmatory hysterosalpingogram 3 months after Essure placement and the cost of laparoscopic tubal occlusion by Filshie clip if the Essure micro-inserts could not be placed. The majority of the cost was related to hospital costs as opposed to physician costs. The Essure procedure had higher costs for disposable equipment (p < .0001), but this was offset by higher charges for operating room costs, which included the recovery room (p < .0001) and pharmacy costs (p < .0001) in the patients in the laparoscopy group. CONCLUSION: In our setting, the Essure hysteroscopic sterilization had significant cost savings compared with laparoscopic tubal sterilization (p = .038). We believe that our data represent the minimum of potential savings using this approach, and future developments will only increase the cost difference found in our study. (C) 2007 AAGL. All rights reserved.