Uterine artery embolization, hysterectomy, or myomectomy for symptomatic uterine fibroids: a cost-utility analysis.
OBJECTIVE
To compare the cost and quality-adjusted life-years (QALYs) of hysterectomy, myomectomy, and uterine artery embolization (UAE) for symptomatic control of uterine fibroids.


METHODS
A cost-utility analysis conducted by using Markov modeling.


METHODS
The analysis was conducted from the perspective of Hong Kong society.


METHODS
A hypothetical cohort of patients presenting with symptomatic uterine fibroids.


METHODS
Hysterectomy, myomectomy, or UAE.


METHODS
Health-care resource use and QALYs over 5 years.


RESULTS
The base-case analysis showed that hysterectomy was the most effective treatment (4.368 QALYs), followed by myomectomy (4.273 QALYs) and UAE (4.245 QALYs) over 5 years. Hysterectomy was less costly (USD8418) (1USD = 7.8HKD) than UAE (USD8847) and myomectomy (USD9036). Monte Carlo 10,000 simulations showed that the hysterectomy group was less costly than the UAE and myomectomy groups 84.1% and 79.1% of the time, and it also gained higher number of QALYs than the UAE and myomectomy groups over 97% of the time.


CONCLUSIONS
Hysterectomy appears to be more cost-effective than myomectomy and UAE for management of symptomatic uterine fibroids over a 5-year period among patients who do not have a preference for uterus-conserving interventions.
You
Joyce H S
JH
Centre for Pharmacoeconomics Research, School of Pharmacy, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, People's Republic of China. joyceyou@cuhk.edu.hk
Sahota
Daljit Singh
DS
Yuen
Pong Mo
PM
D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006723:Hong Kong; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000191:economics*; D007889:Leiomyoma / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D008390:Markov Chains; D018803:Models, Economic; D009215:Myometrium / Q000601:surgery*; D011183:Postoperative Complications / Q000191:economics / Q000601:surgery; D019057:Quality-Adjusted Life Years; D012086:Reoperation / Q000191:economics; D015203:Reproducibility of Results; D013997:Time Factors; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000009:adverse effects / Q000191:economics*; D014594:Uterine Neoplasms / Q000191:economics* / Q000601:surgery / Q000628:therapy*