Cost-effectiveness of Myomectomy versus Hysterectomy in Women with Uterine Fibroids.
J Minim Invasive Gynecol
; 30(10): 813-819, 2023 10.
Article
en En
| MEDLINE
| ID: mdl-37286130
ABSTRACT
STUDY OBJECTIVE:
Increasing evidence suggests that hysterectomy to treat uterine fibroids (UFs), even with ovarian conservation (OC), is associated with a 33% increased risk of coronary artery disease (CAD). We sought to compare the cost-effectiveness of various treatment approaches for UFs to understand the trade-offs among development of CAD vs new fibroids.DESIGN:
We developed a Markov model to include women with UFs who no longer desired pregnancy. The outcomes of interest were quality-adjusted life-years (QALYs) and total treatment costs. We conducted sensitivity analyses to test the effect of uncertain model inputs.SETTING:
Health system perspective. PATIENTS A hypothetical cohort of 10 000 40-year-old women.INTERVENTIONS:
Myomectomy, hysterectomy with OC, and hysterectomy without OC. MEASUREMENTS AND MAINRESULTS:
Myomectomy was the best-value strategy, costing US$528 217 and providing 19.38 QALYs. Neither hysterectomy with OC nor hysterectomy without OC was found to be cost-effective, assuming a willingness-to-pay threshold of $100 000 per QALY gain as hysterectomy with OC provided more benefit than myomectomy at an average cost of $613 144 to gain one additional QALY. The sensitivity analyses showed that if the risk of new symptomatic UFs that required treatment after myomectomy was more than 13%, annually (base case, 3.6%), or the quality of life after myomectomy was less than 0.815 (base case, 0.834), then myomectomy would no longer be cost-effective, under a willingness-to-pay amount of US$100 000.CONCLUSION:
Myomectomy is an optimal treatment of UFs compared with hysterectomy among women aged 40 years. The increased risk of CAD after hysterectomy and its associated costs and the effects on morbidity and quality of life made hysterectomy a costlier and less effective long-term strategy.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Neoplasias Uterinas
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Embolización de la Arteria Uterina
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Miomectomía Uterina
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Leiomioma
Tipo de estudio:
Health_economic_evaluation
Límite:
Female
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Humans
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Pregnancy
Idioma:
En
Revista:
J Minim Invasive Gynecol
Asunto de la revista:
GINECOLOGIA
Año:
2023
Tipo del documento:
Article