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

doi:10.1111/j.1471-0528.2007.01657.x

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Wiley InterScience

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 115 Issue 5, Pages 653 - 662

Published Online: 7 Mar 2008

Published on behalf of the Royal College of Obstetricians and Gynaecologists

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

H Zowall, ^a JA Cairns, ^b C Brewer, ^c DL Lamping, ^b WMW Gedroyc, ^d L Regan ^e

^a McGill University, Montreal, Quebec, Canada ^b Health Services Research Unit, London School of Hygiene & Tropical Medicine, London, UK ^c Zowall Consulting, Montreal, Quebec, Canada Departments of ^d Magnetic Resonance Imaging and ^e Academic Obstetrics and Gynaecology, St Mary's Hospital and Imperial College School of Medicine, London, UK

Correspondence to Prof John Cairns, Public Health & Policy, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT. Tel 0207 927 2395. Email John.Cairns@lshtm.ac.uk

Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.

KEYWORDS

Cost-utility analysis • focused ultrasound surgery • 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. Health-related 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.

Accepted 6 December 2007.

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1471-0528.2007.01657.x About DOI