A multi-centre retrospective cohort study comparing the efficacy, safety and cost-effectiveness of hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids. The HOPEFUL study

Abstract

The study results suggest that both UAE and hysterectomy are safe. No unexpected problems were detected following UAE after a long follow-up period (average 5 years). Complications are less common for UAE than hysterectomy. The cost-effectiveness analysis favours embolisation even after taking account of complications, expected side-effects associated with the procedure and subsequent re-treatments for women with a preference for uterus preservation. It is important to improve the management of expectations following UAE, particularly regarding fertility. The data suggested that fertility and miscarriage rate are consistent with those of age-matched women with fibroids. UAE is an effective treatment for some women with fibroids and our trial supports the National Institute for Health and Clinical Excellence guidance that it should be made available as one of the options for treatment, with a possible reduction in the need for hysterectomy as the first-line treatment. Further research is needed into which women will be treated most successfully by UAE, the best method of achieving effective embolisation, advice for women who desire future fertility, the role of prophylactic antibiotics in UAE, and the effects of HRT use after UAE on recurrence of fibroid symptoms.

Cost-effectiveness of diagnostic strategies for the management of abnormal uterine bleeding (heavy menstrual bleeding and post-menopausal bleeding): a decision analysis

“…However, a study of 397 women that retrospectively followed up women who had had either hysterectomy or UAE reported that 88% of women who had undergone hysterectomy felt that their symptoms were better and that 70% would recommend their treatment to a friend. 118 A disadvantage of this study was that the mean follow-up time was 8.6 years. By scrutinising the reference list of this study, we identified two similar studies.…”

“…54 In total, 17 women underwent hysterectomy and at 6 months 88% reported that they would have the same treatment again, suggesting that they were satisfied with the surgery. 54 After evaluating the data from these studies we decided to use 0.88 as our satisfaction level as this was reported in the large retrospective study 118 and supported by the smaller randomised study. 54 For the sensitivity analysis we used the proportion of women who would recommend their treatment to a friend from the two separate studies (0.70 and 0.93).…”

“…54 For the sensitivity analysis we used the proportion of women who would recommend their treatment to a friend from the two separate studies (0.70 and 0.93). 53,118 No studies were identified that reported satisfaction rates after hysterectomy for endometrial disease in pre-menopausal women. We assumed that women having hysterectomy for atypical hyperplasia or cancer would be 100% satisfied because they would be prevented from developing cancer or treated for their cancer.…”

Value of hysteroscopy prior to uterine artery embolisation for fibroids: a hospital based retrospective study

“…Embolising the uterine blood supply had been used earlier to manage post-partum haemorrhage and as treatment of uterine arterio-venous malformations, but it was the desire to reduce intraoperative haemorrhage at open myomectomy by Professor Jacques Ravina, which serendipitously led to the use of UAE as primary management of this common condition once it was realised that the embolisation lets to fibroid shrinkage and symptomatic improvement [1,2]. Many studies since have confirmed both the benefits and risks of UAE [3,4].…”

Three-dimensional rotational angiography is preferable to conventional two-dimensional techniques for uterine artery embolization

“…terine artery embolization (UAE) has shown to be a valuable, minimally invasive alternative for the treatment of women with symptomatic leiomyomas, uterine vascular malformations, and postpartum hemorrhage (1)(2)(3)(4)(5)(6)(7)(8)(9). The procedure is performed with angiographic and fluoroscopic guidance.…”