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. Design: A cost-utility analysis conducted by using Markov modeling. Setting: The analysis was conducted from the perspective of Hong Kong society. Patient(S): A hypothetical cohort of patients presenting with symptomatic uterine fibroids. Intervention(s): Hysterectomy, myomectomy, or UAE. Main Outcome Measure(S): Health-care resource use and QALYs over 5 years. Result(S): 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. Conclusion(S): 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. (Fertil Steril(R) 2009;91:580-8. (C)2009 by American Society for Reproductive Medicine.)