Outcomes From Leiomyoma Therapies

Spies, James B.; Bradley, Linda D.; Guido, Richard S.; Maxwell, G. Larry; Levine, Betty A.; Coyne, Karin S.

doi:10.1097/aog.0b013e3181ed36b3

Cited by 100 publications

(23 citation statements)

References 16 publications

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“…Spies and colleagues noted significant improvement in the quality of life of patients with symptomatic fibroids following radiologic interventional or surgical (predominantly via laparotomy) treatment, in contrast to the lack of positive changes during the study period an untreated control group [35]. In light of these findings, we found it ethically questionable to assign a portion of patients presenting at our hospital for the treatment of symptomatic fibroids to a non-interventional control group for the purposes of this study.…”

Section: Discussionmentioning

confidence: 91%

Postoperative Quality of Life and Sexual Function in Premenopausal Women Undergoing Laparoscopic Myomectomy for Symptomatic Fibroids: A Prospective Observational Cohort Study

Radosa

Radosa²,

Mavrova

et al. 2016

PLoS ONE

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IntroductionUterine leiomyomas are the most common benign gynecologic tumors. To date laparoscopy myomectomy is the gold standard for treatment of symptomatic fibroids in reproductive-aged women. Detailed counseling about the effects of this procedure on postoperative sexuality and quality of life is important in these patients. However, available data on these subjects are limited and contradictory. The aim of this study was to assess sexual function and quality of life in premenopausal women undergoing laparoscopic myomectomy for symptomatic uterine fibroids.Material and MethodsAll premenopausal women who underwent laparoscopic myomectomy for symptomatic fibroids between April 2012 and August 2014 at a tertiary university center were enrolled in this prospective observational cohort study. Sexual function and quality of life were assessed for the pre- and postoperative (six months post-operatively) state using two validated questionnaires, the Female Sexual Function Index (FSFI) and the European Quality of Life Five-Dimension Scale (EQ-5D).ResultsNinety-five of the 115 (83%) eligible patients completed the study. Overall a significant improvement in quality of life and sexual function was observed in the study cohort: Median FSFI (28 (18.7–35.2)) and EQ-5D scores (1 (0.61–1) after laparoscopic myomectomy were significantly higher than preoperative scores (21.2 (5.2–33.5); 0.9 (0.2–1); p ≤ 0.01). The number, position and localization of the largest fibroids were not correlated with pre- or postoperative sexual function or quality of life.ConclusionLaparoscopic myomectomy might have positive short-term effects on postoperative quality of life and sexual function in premenopausal women suffering from symptomatic fibroids.

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Section: Discussionmentioning

confidence: 91%

Postoperative Quality of Life and Sexual Function in Premenopausal Women Undergoing Laparoscopic Myomectomy for Symptomatic Fibroids: A Prospective Observational Cohort Study

Radosa

Radosa²,

Mavrova

et al. 2016

PLoS ONE

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“…Women with uterine fibroids report a significantly lower health-related quality of life [3], and leiomyomata contribute to increased healthcare costs and decreased work productivity [4]. …”

Section: Introductionmentioning

confidence: 99%

Uterine artery embolization immediately preceding laparoscopic myomectomy

Goldman

Hirshfeld-Cytron

Pavone

et al. 2011

International Journal of Gynecology & Obstetrics

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Objective To determine whether performing uterine artery embolization (UAE) immediately before laparoscopic myomectomy can facilitate a minimally invasive surgical approach for larger uterine fibroids. Methods In a retrospective case–control study, laparoscopic myomectomy with and without preoperative UAE was examined. Data were analyzed from 26 laparoscopic myomectomies performed by a single surgeon at Northwestern University Feinberg School of Medicine between 2004 and 2010. Controls were matched for age, calendar year, surgeon, and number of fibroids removed. Surgical outcomes included preoperative clinical uterine size, operative time, operative blood loss, and postoperative myoma specimen weight. Data were analyzed via 2-tailed Student t test. Results Twelve women underwent laparoscopic myomectomy within 169±16 minutes (mean±SEM) of preoperative UAE. Fourteen control patients underwent laparoscopic myomectomy alone. The UAE group had a greater mean preoperative clinical uterine size (19.7 versus 12.4 weeks, P<0.001) and a greater mean myoma specimen weight measured postoperatively (595.3 versus 153.6 grams, P<0.05). There were no significant differences in operative time or blood loss, and there were no intra-operative complications. Conclusion UAE performed immediately before laparoscopic myomectomy facilitated minimally invasive surgery for larger uteri and larger uterine myomas, with no differences in operative time or blood loss.

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“…As quality-of-life weights were not estimated for myomectomy, we used UAE scores to approximate the effectiveness of myomectomy and varied this assumption in sensitivity analysis. This assumption was supported by the reported equivalence of UAE and myomectomy in both disease-specific and general quality of life measures (UFS-QOL and SF-36)[26] We varied this assumption in sensitivity analysis. To estimate the quality-of-life score for inadequate symptom relief, we used a weighted average of the reported before-treatment scores.…”

Section: Methodsmentioning

confidence: 99%

Cost–effectiveness of uterine-preserving procedures for the treatment of uterine fibroid symptoms in the USA

et al. 2014

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Objective To evaluate cost-effectiveness of the following three treatments of uterine fibroids in a population of premenopausal women who wish to preserve their uteri: myomectomy, MR-guided focused ultrasound (MRgFUS) and uterine artery embolization (UAE). Methods A decision analytic Markov model was constructed. Cost-effectiveness was calculated in terms of U.S. dollars per quality adjusted life year (QALY) over five years. Two types of costs were calculated: direct costs only, and the sum of direct and indirect (productivity) costs. Women in the hypothetical cohort were assessed for treatment type eligibility, were treated based on eligibility, and experienced adequate or inadequate symptom relief. Additional treatment (myomectomy) occurred for inadequate symptom relief or recurrence. Sensitivity analysis was conducted to evaluate uncertainty in the model parameters. Results In the base-case, myomectomy, MRgFUS and UAE had the following combinations of mean cost and mean QALYs, respectively: ($15,459, 3.957), ($15,274, 3.953) and ($18,653, 3.943). When incorporating productivity costs, MRgFUS incurred mean cost of $21,232; myomectomy $22,599; and UAE $22,819. Using probabilistic sensitivity analysis (PSA) and excluding productivity costs, myomectomy was cost-effective at almost every decision threshold. Using PSA and incorporating productivity costs, myomectomy was cost-effective at decision thresholds above $105,000/QALY; MRgFUS between $30,000-$105,000/QALY; and UAE below $30,000/QALY. Conclusions Myomectomy, MRgFUS, and UAE were similarly effective in terms of QALYs gained. Depending on assumptions about costs and willingness-to-pay for additional QALYs, all three treatments can be deemed cost-effective in a five year time frame.

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Outcomes From Leiomyoma Therapies

Abstract: II.

Cited by 100 publications

References 16 publications

Postoperative Quality of Life and Sexual Function in Premenopausal Women Undergoing Laparoscopic Myomectomy for Symptomatic Fibroids: A Prospective Observational Cohort Study

Postoperative Quality of Life and Sexual Function in Premenopausal Women Undergoing Laparoscopic Myomectomy for Symptomatic Fibroids: A Prospective Observational Cohort Study

Uterine artery embolization immediately preceding laparoscopic myomectomy

Cost–effectiveness of uterine-preserving procedures for the treatment of uterine fibroid symptoms in the USA

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