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

Abstract

Objective: To evaluate the cost-effectiveness of the following three treatments of uterine fibroids in a population of premenopausal women who wish to preserve their uteri: myomectomy, magnetic resonance-guided focused ultrasound (MRgFUS) and uterine artery embolization (UAE).

Materials & methods: A decision analytic Markov model was constructed. Cost-effectiveness was calculated in terms of US$ per quality-adjusted life year (QALY) over 5 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: US$15,459, 3.957; US$15,274, 3.953; and US$18,653, 3.943. When incorporating productivity costs, MRgFUS incurred a mean cost of US$21,232; myomectomy US$22,599; and UAE US$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 US$105,000/QALY; MRgFUS was cost effective between US$30,000 and US$105,000/QALY; and UAE was cost effective below US$30,000/QALY.

Conclusion: 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 5-year time frame.

Keywords: MRgFUS; Markov model; UAE; cost–effectiveness; magnetic resonance-guided focused ultrasound; myomectomy; uterine artery embolization; uterine fibroids; uterine-preserving treatments.

Figure 1. Model Schematic

*Those who experience inadequate relief or fibroid recurrence will undergo myomectomy treatment (‘second-line’ treatment). **Complications can occur after treatment.

Figure 2

a. Percentage of Simulations found to be Cost-Effective, at Various Decision Threshold Values, Productivity Costs Excluded b. Percentage of Simulations found to be Cost-Effective, at Various Decision Threshold, Productivity Costs Included

Figure 2

a. Percentage of Simulations found to be Cost-Effective, at Various Decision Threshold Values, Productivity Costs Excluded b. Percentage of Simulations found to be Cost-Effective, at Various Decision Threshold, Productivity Costs Included