MRI-guided focused ultrasound surgery for uterine fibroid treatment: A cost-effectiveness analysis

Chung Y. Kong, Lesley Meng, Zehra B. Omer, J. Shannon Swan, Serene Srouji, G. Scott Gazelle, Fiona M. Fennessy

Research output: Contribution to journalArticlepeer-review

33 Scopus citations

Abstract

OBJECTIVE. The purpose of this article is to evaluate the cost effectiveness of a treatment strategy for symptomatic uterine fibroids that uses MRI-guided focused ultrasound as a first-line therapy relative to uterine artery embolization (UAE) or hysterectomy. MATERIALS AND METHODS. We developed a decision-analytic model to compare the cost effectiveness of three first-line treatment strategies: MRI-guided focused ultrasound, UAE, and hysterectomy. Treatment-specific short- and long-term utilities, lifetime costs, and quality-adjusted life years (QALYs) were incorporated, allowing us to conduct an incremental cost-effectiveness analysis, using a societal willingness-to-pay (WTP) threshold of $50,000/QALY to designate a strategy as cost effective. Sensitivity analyses were subsequently RESULTS. In the base-case analysis, UAE as a first-line treatment of symptomatic fibroids was the most effective and expensive strategy (22.75 QALYs; $22,968), followed by MRI-guided focused ultrasound (22.73 QALYs; $20,252) and hysterectomy (22.54 QALYs; $11,253). MRI-guided focused ultrasound was cost effective relative to hysterectomy, with an associated incremental cost-effectiveness ratio (ICER) of $47,891/QALY. The ICER of UAE relative to MRI-guided focused ultrasound was $234,565/QALY, exceeding the WTP threshold of $50,000/QALY, therefore rendering MRI-guided focused ultrasound also cost effective relative to UAE. In sensitivity analyses, results were robust to changes in most parameters but were sensitive to changes in probabilities of recurrence, symptom relief, and quality-of-life measures. CONCLUSION. First-line treatment of eligible women with MRI-guided focused ultrasound is a cost-effective noninvasive strategy. For those not eligible for MRI-guided focused ultrasound, UAE remains a cost-effective option. These recommendations integrate both the short- and long-term decrements in quality of life associated with the specific treatment modalities. performed on all key parameters.

Original languageEnglish
Pages (from-to)361-371
Number of pages11
JournalAmerican Journal of Roentgenology
Volume203
Issue number2
DOIs
StatePublished - Aug 2014
Externally publishedYes

Keywords

  • Cost effectiveness
  • Hysterectomy
  • MRI-guided focused ultrasound
  • Uterine fibroids

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