Abstract
The search for cost-effective alternatives to hysterectomy in treating uterine fibroids has extended to magnetic resonance-guided focused ultrasound surgery (MRgFUS), in which a noninvasive thermal ablation device is integrated with MR imaging to ablate soft tissue. A small bean-shaped volume of focused ultrasound energy is directed into the target for about 15 seconds to heat the tissue to 60-90° and induce thermal coagulation. Cost utility analysis was based on a Markov model, the parameters of which were drawn from a series of clinical studies of MRgFUS and from literature dealing with clinical efficacy. Costs were estimated from the perspective of the National Health Service Trusts in England and Wales. The major outcome measure was incremental cost-effectiveness, estimated by cost per quality-adjusted life-year (QALY) gained. The base-case results imply a cost saving and a small QALY gain per woman resulting from MRgFUS treatment. The cost per QALY gained was sensitive to the cost of MRgFUS relative to other treatments such as hysterectomy, myomectomy, and uterine artery embolization. It also was sensitive to patient age and to the nonperfused volume relative to the total volume of fibroids. The investigators conclude that MRgFUS is likely to be a cost-effective initial strategy for treating symptomatic uterine fibroids.
Highlights
Uterine fibroids are benign clonal tumours of the smooth muscle cells of the uterus.[1,2] They are the most common benign tumours in women during their reproductive years, with an estimated cumulative incidence of about 40% for white women aged 35–39, rising to over 60% in women aged 45–49.3,4 Symptoms attributable to fibroids can be classified into three categories: abnormal uterine bleeding, pelvic pressure and pain, and reproductive dysfunc-Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.tion
The aim of this study is to estimate the cost-effectiveness of a treatment strategy for symptomatic uterine fibroids with MRgFUS as compared with current practice comprising uterine artery embolisation (UAE), myomectomy and hysterectomy
In scenario 2, the assumption regarding current practice in the UK for the management of uterine fibroids is changed to UAE (33.33%), myomectomy (33.33%), and hysterectomy (33.33%), rather than the base-case scenario of 25, 25 and 50%, across the three treatments, respectively
Summary
Hysterectomy is a major operation that causes considerable disability within 2 months of surgery, has mortality rates in the range of 0.38–1 per 1000, severe complications in 3% of women and minor a 2008 The Authors Journal compilation a RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology morbidity in up to 30% women.[3] Hysterectomy is thought to be associated with long-term consequences such as urinary incontinence years after the operation, which may cause early ovarian failure, and has significant cost implications This has stimulated the search for clinically and cost-effective alternatives to hysterectomy, which provide comparable quality of life and fewer adverse effects and complications than hysterectomy.[3] Established treatments for uterine fibroids include hysterectomy, myomectomy and uterine artery embolisation (UAE); endometrial ablative techniques are among emerging new technologies
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