Cost-Effectiveness of Magnetic Resonance-Guided Focused Ultrasound Surgery for Treatment of Uterine Fibroids

Abstract

Objective To 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.Design Cost-utility analysis based on a Markov model.Setting National Health Service (NHS) Trusts in England and Wales.Population Women for whom surgical treatment for uterine fibroids is being considered.Methods The 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. Healthrelated 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 measures Incremental cost-effectiveness measured by cost per quality-adjusted life-year (QALY) gained.Results The 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.Conclusions A treatment strategy for symptomatic uterine fibroids starting with MRgFUS is likely to be cost-effective.Keywords Cost-utility analysis, focused ultrasound surgery, uterine fibroids.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.

Magnetic resonance‐guided focused ultrasound (MRgFUS) compared with abdominal hysterectomy for treatment of uterine leiomyomas

“…MRgFUS surgery for leiomyomas shows treatment efficacy for at least 24 months following treatment in both single‐institution series and multicenter collaborative trials3, 14–21. Furthermore, MRgFUS represents a cost‐effective treatment option for symptomatic leiomyomas in some healthcare systems22.…”

Cost‐effectiveness of hysterectomy for benign gynecological conditions: a systematic review

“…However, during longer follow‐up of 5 years there were no differences in cost‐effectiveness due to the need of additional interventions . The new treatment strategy of magnetic resonance‐guided focused ultrasound surgery was more cost‐effective than the current practice of treatment of uterine fibroids .…”

“…Only 11 studies plus two follow‐up studies of a previously published cohort (adding up to 54.2% of studies) had obtained HRQoL data from their own cohort. Others used results published elsewhere. Of eight studies on the cost‐effectiveness of treatment of uterine fibroids, three had HRQoL data of their own patient material.…”

“…It is also noteworthy that only half of the studies used their own patient data (, follow‐up studies of previously published cohort : ). The other half used HRQoL data already published elsewhere . Of this latter half, the HRQoL data originated from only a few patient cohorts and thus a large proportion of published cost‐effectiveness results of hysterectomy stem from the same patient materials.…”

A comparison of the cost–utility of ultrasound‐guided high‐intensity focused ultrasound and hysterectomy for adenomyosis: a retrospective study

“…A few studies have compared the cost‐effectiveness of hysterectomy and magnetic resonance‐guided focused ultrasound surgery (MRgFUS) for uterine fibroids . However, no study has yet compared the cost–utility of USgHIFU and hysterectomy for the treatment of adenomyosis.…”