Dikshyanta Rana1, Olivia Wu1, Versha Cheed2, Lee J Middleton2, Jonathan Moss3, Mary Ann Lumsden3, William McKinnon2, Jane Daniels4, Fusun Sirkeci5, Isaac Manyonda6, Anna-Maria Belli7, Klim McPherson8. 1. Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, University of Glasgow, G12 8RZ, Glasgow, UK. 2. Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT, UK. 3. School of Medicine, University of Glasgow, Glasgow, G31 2ER, UK. 4. Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, NG7 2RD, UK. 5. Department of Obstetrics and Gynaecology, Whipps Cross Hospital, London, E11 1NR, UK. 6. Department of Gynaecology, St George's Hospital and Medical School, London, SW17 0QT, UK. 7. Department of Radiology, St George's Hospital and Medical School, London, SW17 0QT, UK. 8. Department of Primary Care, University of Oxford, OX3 9DU, Oxford, UK.
Abstract
OBJECTIVES: To assess the cost-effectiveness of uterine artery embolization (UAE) and myomectomy for women with symptomatic uterine fibroids wishing to avoid hysterectomy. DESIGN: Economic evaluation alongside the FEMME randomised controlled trial. SETTING: 29 UK hospitals. POPULATION: Premenopausal women who had symptomatic uterine fibroids amenable to UAE or myomectomy wishing to avoid hysterectomy. 254 women were randomised to UAE (127) and myomectomy (127). METHODS: A within trial cost-utility analysis was conducted from the perspective of the UK NHS. MAIN OUTCOME MEASURES: Quality-adjusted life years measured using the EuroQoL 3L, combined with costs to estimate cost-effectiveness over two and four years of follow-up. RESULTS: Over a two-year time horizon, UAE was associated with higher mean costs (difference £645; 95% CI -1,381 to 2,580) and lower QALYs (difference -0.09; 95% CI -0.11 to -0.04) when compared with myomectomy. Similar results were observed over the four-year time horizon. Thus, UAE was dominated by myomectomy. Results of the sensitivity analyses were consistent with the basecase results for both years. Over two years, UAE was associated with higher costs (difference £456; 95% CI -1,823; 3,164) and lower QALYs (difference -0.06; 95% CI (-0.11; -0.02). CONCLUSIONS:Myomectomy is a cost-effective option for the treatment of uterine fibroids. The differences in costs and quality-adjusted life years are small. Women should be fully informed and have the option to choose between the two procedures. This article is protected by copyright. All rights reserved.
RCT Entities:
OBJECTIVES: To assess the cost-effectiveness of uterine artery embolization (UAE) and myomectomy for women with symptomatic uterine fibroids wishing to avoid hysterectomy. DESIGN: Economic evaluation alongside the FEMME randomised controlled trial. SETTING: 29 UK hospitals. POPULATION: Premenopausal women who had symptomatic uterine fibroids amenable to UAE or myomectomy wishing to avoid hysterectomy. 254 women were randomised to UAE (127) and myomectomy (127). METHODS: A within trial cost-utility analysis was conducted from the perspective of the UK NHS. MAIN OUTCOME MEASURES: Quality-adjusted life years measured using the EuroQoL 3L, combined with costs to estimate cost-effectiveness over two and four years of follow-up. RESULTS: Over a two-year time horizon, UAE was associated with higher mean costs (difference £645; 95% CI -1,381 to 2,580) and lower QALYs (difference -0.09; 95% CI -0.11 to -0.04) when compared with myomectomy. Similar results were observed over the four-year time horizon. Thus, UAE was dominated by myomectomy. Results of the sensitivity analyses were consistent with the basecase results for both years. Over two years, UAE was associated with higher costs (difference £456; 95% CI -1,823; 3,164) and lower QALYs (difference -0.06; 95% CI (-0.11; -0.02). CONCLUSIONS: Myomectomy is a cost-effective option for the treatment of uterine fibroids. The differences in costs and quality-adjusted life years are small. Women should be fully informed and have the option to choose between the two procedures. This article is protected by copyright. All rights reserved.
Authors: Jane Daniels; Lee J Middleton; Versha Cheed; William McKinnon; Dikshyanta Rana; Fusun Sirkeci; Isaac Manyonda; Anna-Maria Belli; Mary Ann Lumsden; Jonathan Moss; Olivia Wu; Klim McPherson Journal: Health Technol Assess Date: 2022-04 Impact factor: 4.106
Authors: Jane Daniels; Lee J Middleton; Versha Cheed; William McKinnon; Fusun Sirkeci; Isaac Manyonda; Anna-Maria Belli; Mary Ann Lumsden; Jonathan Moss; Olivia Wu; Klim McPherson Journal: Eur J Obstet Gynecol Reprod Biol X Date: 2021-11-20