Abstract
To assess the cost-effectiveness of uterine artery embolisation (UAE) and myomectomy for women with symptomatic uterine fibroids wishing to avoid hysterectomy. Economic evaluation alongside the FEMME randomised controlled trial. 29 UK hospitals. Premenopausal women who had symptomatic uterine fibroids amenable to UAE or myomectomy wishing to avoid hysterectomy. 254 women were randomised to UAE (127) and myomectomy (127). A within-trial cost-utility analysis was conducted from the perspective of the UK NHS. Quality-adjusted life years (QALYs) measured using the EuroQoL EQ-5D-3L, combined with costs to estimate cost-effectiveness over 2 and 4years of follow-up. Over a 2-year time horizon, UAE was associated with higher mean costs (difference £645; 95% CI -1381 to 2580) and lower QALYs (difference -0.09; 95% CI -0.11 to -0.04) when compared with myomectomy. Similar results were observed over the 4-year time horizon. Thus, UAE was dominated by myomectomy. Results of the sensitivity analyses were consistent with the base case results for both years. Over 2years, UAE was associated with higher costs (difference £456; 95% CI -1823 to 3164) and lower QALYs (difference -0.06; 95% CI -0.11 to -0.02). Myomectomy is a cost-effective option for the treatment of uterine fibroids. The differences in costs and QALYs are small. Women should be fully informed and have the option to choose between the two procedures. Fully informed women with uterine fibroids should have a choice between uterine artery embolisation or myomectomy.
Highlights
The current UK guidance from the National Institute for Health and Clinical Excellence (NICE) on treatment for uterine fibroids recommends uterine artery embolisation (UAE)as a non-surgical alternative option for women who do not wish to have surgery and/or who wish to preserve their fertility
This study aims to determine the cost-effectiveness of UAE and myomectomy by performing an economic evaluation alongside the FEMME trial
UAE was associated with higher costs (£645 difference; 95% CI À1381 to 2580) and lower quality-adjusted life years (QALYs) (À0.09 difference; 95% CI À0.11 to À0.04) compared with myomectomy over a time horizon of 2 years
Summary
The main approach is to recommend surgical treatments (hysterectomy and myomectomy), the latter of which conserves the uterus. Another non-invasive option is high-intensity transcutaneous focused ultrasound (MRgHIFU) – NICE notes that there is adequate evidence of short-term efficacy, but it is only used in the UK with special arrangements or for research purposes.[1]. Few studies have evaluated the cost-effectiveness of treatments available for symptomatic fibroids. These studies focused on pre-menopausal women over 25 years old until menopause. In these studies, UAE2–10 was compared with
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