6 Implications for the NHS
6.1 The impact of second-generation EA techniques on the NHS budget will depend on the number of women eligible for each technique and the uptake rates, which will be greatly influenced by the preferences of patients and clinicians.
6.2 It is estimated that around 26,000 hysterectomies are performed in the UK each year for HMB and a further 16,000 EAs are carried out, of which about 2000 are performed using second-generation techniques. The Assessment Group estimated that if all hysterectomies were replaced by EA, the annual cost saving would be of the order of £29 million, assuming half of the procedures were replaced by firstgeneration techniques, and the remaining half were split between TBEA and MEA. Under a hypothetical scenario of all hysterectomies being replaced by second-generation EA techniques, the cost saving would be more than £32 million per annum. However, these figures represent ceilings of the potential cost savings, and it is highly unlikely that all hysterectomies for HMB will be replaced by EA, because hysterectomy will remain the most appropriate option for some women. Also, it is unlikely that such savings would be realised in financial terms for two reasons: the estimates represent amounts of resources that would remain within the system (but might nevertheless be redeployed); and the estimates are based on average costs (for example, of days in hospital avoided), some of which are fixed and therefore would not be saved, but could be available for other purposes.