Uterine artery embolization, hysterectomy, or myomectomy for symptomatic uterine fibroids: a cost-utility analysis

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• 作者：Joyce H.S. You ; Daljit Singh Sahota ; Pong Mo Yuen
• 关键词：Cost-utility analysis ; uterine fibroids ; uterine artery embolization ; hysterectomy ; myomectomy
• 刊名：Fertility and Sterility
• 出版年：2009
• 出版时间：February 2009
• 年：2009
• 卷：91
• 期：2
• 页码：580-588
• 全文大小：180 K

文摘

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.