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Comparative Study
. 2009 Jan;25(1):14-25.
doi: 10.1017/S0266462309090035.

Cost-effectiveness of magnetic resonance guided focused ultrasound for the treatment of uterine fibroids

Amy K O'Sullivan  1 , David Thompson, Paula Chu, David W Lee, Elizabeth A Stewart, Milton C Weinstein
Affiliations
Comparative Study

Cost-effectiveness of magnetic resonance guided focused ultrasound for the treatment of uterine fibroids

Amy K O'Sullivan et al. Int J Technol Assess Health Care. 2009 Jan.

Abstract

Objectives: The aim of this study is to evaluate the cost-effectiveness of Magnetic Resonance Guided Focused Ultrasound (MRgFUS) compared with alternative treatments for uterine fibroids in the United States.

Methods: We used techniques of decision analysis and data from secondary sources to develop and estimate an economic model of the management of uterine fibroids among premenopausal women. Patients in the model receive treatment with MRgFUS, uterine artery embolization (UAE), abdominal myomectomy, hysterectomy, or pharmacotherapy. The model predicts total costs (including subsequent procedures) and quality-adjusted life-years (QALYs) for each treatment strategy over a lifetime horizon, discounted at 3 percent, from a societal perspective. Data on treatment efficacy and safety were obtained from published and unpublished studies. Costs (2005 US$) were obtained from an analysis of a large administrative database and other secondary sources. Lost productivity costs were included in the base-case analysis, but excluded in a sensitivity analysis.

Results: UAE was associated with the most QALYs (17.39), followed by MRgFUS (17.36), myomectomy (17.31), hysterectomy (17.18), and pharmacotherapy (16.70). Pharmacotherapy was the least costly strategy ($9,200 per patient), followed by hysterectomy ($19,800), MRgFUS ($27,300), UAE ($28,900), and myomectomy ($35,100). Incremental cost-effectiveness ratios (cost per QALY gained) were $21,800 for hysterectomy, $41,400 for MRgFUS, and $54,200 for UAE; myomectomy was more costly and less effective than both MRgFUS and UAE. Results were sensitive to MRgFUS recurrence rates, MRgFUS procedure costs, and assumptions about quality of life following hysterectomy.

Conclusions: Our findings suggest that MRgFUS is in the range of currently accepted criteria for cost-effectiveness, along with hysterectomy and UAE.

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Figures

Figure 1a
Figure 1a
Screening and eligibility for treatments for uterine fibroids.
Figure 1b
Figure 1b
Outcomes associated with treatments for uterine fibroids.
Figure 2
Figure 2
Total costs by component per patient receiving alternative uterine fibroid treatments.
See this image and copyright information in PMC

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