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

Amy K. O'Sullivan, David Thompson, Paula Chu, David W. Lee, Elizabeth A Stewart, Milton C. Weinstein

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Objectives: The aim of this study is to evaluate the cost-effectiveness of Magnetic Resonance Guided Focused Ultrasound (MRgFUS) compared with alternative treatments for uterine fibroids in the United States. Methods: We used techniques of decision analysis and data from secondary sources to develop and estimate an economic model of the management of uterine fibroids among premenopausal women. Patients in the model receive treatment with MRgFUS, uterine artery embolization (UAE), abdominal myomectomy, hysterectomy, or pharmacotherapy. The model predicts total costs (including subsequent procedures) and quality-adjusted life-years (QALYs) for each treatment strategy over a lifetime horizon, discounted at 3 percent, from a societal perspective. Data on treatment efficacy and safety were obtained from published and unpublished studies. Costs (2005 US$) were obtained from an analysis of a large administrative database and other secondary sources. Lost productivity costs were included in the base-case analysis, but excluded in a sensitivity analysis. Results: UAE was associated with the most QALYs (17.39), followed by MRgFUS (17.36), myomectomy (17.31), hysterectomy (17.18), and pharmacotherapy (16.70). Pharmacotherapy was the least costly strategy ($9,200 per patient), followed by hysterectomy ($19,800), MRgFUS ($27,300), UAE ($28,900), and myomectomy ($35,100). Incremental cost-effectiveness ratios (cost per QALY gained) were $21,800 for hysterectomy, $41,400 for MRgFUS, and $54,200 for UAE; myomectomy was more costly and less effective than both MRgFUS and UAE. Results were sensitive to MRgFUS recurrence rates, MRgFUS procedure costs, and assumptions about quality of life following hysterectomy. Conclusions: Our findings suggest that MRgFUS is in the range of currently accepted criteria for cost-effectiveness, along with hysterectomy and UAE.

Original languageEnglish (US)
Pages (from-to)14-25
Number of pages12
JournalInternational Journal of Technology Assessment in Health Care
Volume25
Issue number1
DOIs
StatePublished - Jan 2009

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Leiomyoma
Uterine Artery Embolization
Cost-Benefit Analysis
Uterine Myomectomy
Magnetic Resonance Spectroscopy
Hysterectomy
Quality-Adjusted Life Years
Costs and Cost Analysis
Therapeutics
Drug Therapy
Economic Models
Decision Support Techniques
Information Storage and Retrieval
Quality of Life
Databases
Safety
Recurrence

Keywords

  • Cost-effectiveness
  • Markov model
  • Uterine fibroids

ASJC Scopus subject areas

  • Health Policy

Cite this

Cost-effectiveness of magnetic resonance guided focused ultrasound for the treatment of uterine fibroids. / O'Sullivan, Amy K.; Thompson, David; Chu, Paula; Lee, David W.; Stewart, Elizabeth A; Weinstein, Milton C.

In: International Journal of Technology Assessment in Health Care, Vol. 25, No. 1, 01.2009, p. 14-25.

Research output: Contribution to journalArticle

O'Sullivan, Amy K. ; Thompson, David ; Chu, Paula ; Lee, David W. ; Stewart, Elizabeth A ; Weinstein, Milton C. / Cost-effectiveness of magnetic resonance guided focused ultrasound for the treatment of uterine fibroids. In: International Journal of Technology Assessment in Health Care. 2009 ; Vol. 25, No. 1. pp. 14-25.
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