NEW YORK (Reuters Health) – Assuming a woman does not prefer a uterus-conserving procedure, hysterectomy is more cost-effective than myomectomy or uterine artery embolization (UAE) for treating symptomatic uterine fibroids, new research suggests.
Prior studies have yielded conflicting results regarding the cost-effectiveness of these interventions depending on which costs were included in the analysis, according to the report in the February issue of Fertility and Sterility.
The present investigation used Markov modeling to conduct a cost-utility analysis on a hypothetical cohort of patients in Hong Kong. The main outcome measures were healthcare use and quality-adjusted life years (QALYs) over a 5-year period.
Over the study period, the base case analysis indicated 4.368 QALYs with hysterectomy, 4.237 with myomectomy, and 4.245 with UAE, Dr. Joyce H. S. You, from The Chinese University of Hong Kong, Shat Tin, and colleagues report.
The total patient costs were $8418, $8847, and $9036 with hysterectomy, UAE and myomectomy, respectively.
On Monte Carlo simulations, hysterectomy was found to be less costly than myomectomy and UAE, 79.1% and 84.1% of the time, respectively. In addition, QALYs with hysterectomy exceeded those with myomectomy and UAE over 97% of the time.
“For the first year of treatment, UAE appears to be the dominant treatment option,” the authors point out. However, “over 5 years, hysterectomy appears to be the least costly and most effective treatment option, from the Hong Kong society’s perspective, because the reintervention cost of hysterectomy is the lowest.”
Fertil Steril 2009;91:580-588.