Abstract
ObjectiveTo estimate the cost-effectiveness of a treatment strategy for symptomatic uterine fibroids, which starts with Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) as compared with current practice comprising uterine artery embolisation, myomectomy and hysterectomy.DesignCost-utility analysis based on a Markov model.SettingNational Health Service (NHS) Trusts in England and Wales.PopulationWomen for whom surgical treatment for uterine fibroids is being considered.MethodsThe parameters of the Markov model of the treatment of uterine fibroids are drawn from a series of clinical studies of MRgFUS, and from the clinical effectiveness literature. Health-related quality of life is measured using the 6D. Costs are estimated from the perspective of the NHS. The impact of uncertainty is examined using deterministic and probabilistic sensitivity analysis.Main outcome measuresIncremental cost-effectiveness measured by cost per quality-adjusted life-year (QALY) gained.ResultsThe base-case results imply a cost saving and a small QALY gain per woman as a result of an MRgFUS treatment strategy. The cost per QALY gained is sensitive to cost of MRgFUS relative to other treatments, the age of the woman and the nonperfused volume relative to the total fibroids volume.ConclusionsA treatment strategy for symptomatic uterine fibroids starting with MRgFUS is likely to be cost-effective.Please cite this paper as: Zowall H, Cairns J, Brewer C, Lamping D, Gedroyc W, Regan L. Cost-effectiveness of magnetic resonance-guided focused ultrasound surgery for treatment of uterine fibroids. BJOG 2008;115:653–662.
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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