title: Cost-Effectiveness Analysis of Morcellation Hysterectomy for Myomas.
abstract: OBJECTIVE
  To estimate the cost-effectiveness of eliminating morcellation in the surgical treatment of leiomyomas from a societal perspective.
  
  
  METHODS
  Cost-effectiveness analysis.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  A theoretical cohort of women undergoing hysterectomy for myoma disease large enough to require morcellation.
  
  
  METHODS
  None.
  
  
  METHODS
  None.
  
  
  METHODS
  A decision analysis model was constructed using probabilities, costs, and utility data from published sources. A cost-effectiveness analysis analyzing both quality-adjusted life years (QALYs) and cases of disseminated cancer was performed to determine the incremental cost-effectiveness ratio (ICER) of eliminating morcellation as a tool in the surgical treatment of leiomyomas. Costs and utilities were discounted using standard methodology. The base case included health care system costs and costs incurred by the patient for surgery-related disability. One-way sensitivity analyses were performed to assess the effect of various assumptions.
  
  
  RESULTS
  The cost to prevent 1 case of disseminated cancer was $10 540 832. A strategy of nonmorcellation hysterectomy via laparotomy costed more ($30 359.92 vs $20 853.15) and yielded more QALYs (21.284 vs 21.280) relative to morcellation hysterectomy. The ICER for nonmorcellation hysterectomy compared with morcellation hysterectomy was $2 184 172 per QALY. Health care costs (prolonged hospitalizations) and costs to patients of prolonged time away from work were the primary drivers of cost differential between the 2 strategies. Even when the incidence of occult sarcoma in leiomyoma surgery was ranged to twice that reported in the literature (.98%), the ICER for nonmorcellation hysterectomy was $644 393.30.
  
  
  CONCLUSIONS
  Eliminating morcellation hysterectomy as a treatment for myomas is not cost-effective under a wide variety of probability and cost assumptions. Performing laparotomy for all patients who might otherwise be candidates for morcellation hysterectomy is a costly policy from a societal perspective.
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Pietro
authors.initials: P
authors.lastname: Bortoletto
authors.affiliation: Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Brett D
authors.initials: BD
authors.lastname: Einerson
authors.affiliation: Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Miller
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: mmilad@nmh.org.
authors.forename: Magdy P
authors.initials: MP
authors.lastname: Milad
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D010535:Laparoscopy / Q000191:economics*; D007889:Leiomyoma / Q000191:economics* / Q000601:surgery*; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012938:Social Perception; D014594:Uterine Neoplasms / Q000191:economics* / Q000601:surgery*
keywords: Cost-effectiveness; Hysterectomy; Leiomyosarcoma; Morcellator