title: 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).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Anne H
authors.initials: AH
authors.lastname: Cain-Nielsen
authors.forename: James P
authors.initials: JP
authors.lastname: Moriarty
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Stewart
authors.forename: Bijan J
authors.initials: BJ
authors.lastname: Borah
mesh_terms: D003362:Cost-Benefit Analysis / Q000191:economics / Q000379:methods*; D003661:Decision Support Techniques; D004621:Embolization, Therapeutic / Q000191:economics* / Q000379:methods; D005260:Female; D057086:High-Intensity Focused Ultrasound Ablation / Q000191:economics* / Q000379:methods; D006801:Humans; D007889:Leiomyoma / Q000191:economics* / Q000628:therapy*; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D014481:United States; D063186:Uterine Myomectomy / Q000191:economics* / Q000379:methods; D014599:Uterus / Q000601:surgery
keywords: MRgFUS; Markov model; UAE; cost–effectiveness; magnetic resonance-guided focused ultrasound; myomectomy; uterine artery embolization; uterine fibroids; uterine-preserving treatments