Cost-Effectiveness Analysis of Morcellation Hysterectomy for Myomas

Bortoletto, Pietro; Einerson, Brett D.; Milad, Magdy P.

doi:10.1016/j.jmig.2015.03.015

Cited by 23 publications

(15 citation statements)

References 47 publications

(32 reference statements)

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“…However, other studies have noted that open laparotomies are not cost-effective compared with laparoscopic myomectomies. 30 Our study demonstrated that the prevalence of LMS is actually higher than previously reported and occurs in a younger population, which challenges these studies and possibly indicates that screening is the optimal approach.…”

Section: Discussioncontrasting

confidence: 78%

“…Siedhoff and colleagues counter this thought in their hypothetical analysis demonstrating minimal difference in open and laparoscopic myomectomies based on previously reported prevalence data at the time of myomectomies. However, other studies have noted that open laparotomies are not cost‐effective compared with laparoscopic myomectomies . Our study demonstrated that the prevalence of LMS is actually higher than previously reported and occurs in a younger population, which challenges these studies and possibly indicates that screening is the optimal approach.…”

Section: Discussioncontrasting

confidence: 67%

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MRI screening for uterine leiomyosarcoma

Tong

Kang

Huang

et al. 2019

Magnetic Resonance Imaging

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Background Uterine fibroids are a common benign tumor and can be symptomatic, necessitating resection. Surgical myomectomy is an effective treatment option with a risk of disseminating occult uterine leiomyosarcoma (LMS), creating a need for an effective presurgical screening protocol. Clinical collaboration with contrast‐enhanced MRI including T2 and diffusion‐weighted imaging (DWI) can be utilized as a screening exam. Purpose To review the accuracy and feasibility of an interdisciplinary prospective contrast‐enhanced MRI pelvis with DWI screening system for LMS prior to fibroid resection. Study Type Retrospective cohort study. Population In all, 1960 adult female patients aged 18–87 undergoing screening MRI pelvis prior to uterine fibroid resection. Field Strength/Sequence T1 and T2‐weighted imaging, DWI, and contrast‐enhanced images were acquired at 1.5 T and 3.0 T. Assessment Each radiologist at the time of clinical study prospectively designated a confidence level of presence of LMS in the impression, which was reviewed retrospectively. A separate retrospective evaluation of the histologically proven LMS and the false positives was performed for the presence of five MRI features of LMS including low ADC values, intermediate/high T2 signal intensity, irregular margins, hemorrhage, and necrosis. A preliminary cost‐effectiveness analysis was performed, comparing the costs of treatment of uterine fibroids with vs. without a collaborative screening protocol using MRI. Statistical Tests Sensitivity, specificity, positive predictive value, and negative predictive value were obtained from the prospective evaluations. Student's t‐tests were used to compare demographics and apparent diffusion coefficient values between LMS and false‐positive results. Results We prospectively identified LMS patients with 100% sensitivity and 97% specificity. Preliminary cost analysis demonstrated that the MR screening protocol increased life expectancy by 0.04 years at a cost of $12,937 per life‐year gained. Data Conclusion MRI is an effective and potentially economic screening test, especially with standardized reporting and coordination with clinicians. Level of Evidence: 3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019.

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Section: Discussioncontrasting

confidence: 78%

Section: Discussioncontrasting

confidence: 67%

MRI screening for uterine leiomyosarcoma

Tong

Kang

Huang

et al. 2019

Magnetic Resonance Imaging

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“…Recent cost effectiveness analyses support the use of morcellation in low-risk populations, citing lowerratesofintraoperativeandperioperative complications, 65,66 fewer overall deaths, 65,66 andlowersocietalcostsduetoshorterhospitalizations and fewer days lost from work compared with laparotomy. 66,67 Quality of life analyses have yielded conflicting results [65][66][67] ; however, ageseems to be the driving factor in determining the effectiveness of morcellation. 65,66 Younger women seem to benefit from the procedure; however, as the risk of occult malignancy increases with age, the risks outweigh the benefits.…”

Section: Recommendations/future Directions/cost Effectivenessmentioning

confidence: 99%

Risk of Occult Uterine Sarcoma in Presumed Uterine Fibroids

Cui

Wright

2016

Clinical Obstetrics &Amp; Gynecology

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Symptomatic fibroids are a common indication for hysterectomy or myomectomy. Although rare, unexpected gynecologic malignancies in presumed fibroids have been documented. In cases where tissue retrieval is performed through morcellation, there is increasing concern that intra-abdominal dispersion of occult uterine malignancies may lead to peritoneal dissemination and worse outcomes. We examined the available literature to determine the prevalence of all uterine cancers in women undergoing hysterectomy or myomectomy for benign uterine disease, with attention to the risk of morcellating occult uterine sarcomas. We also reviewed the available tools for preoperative discrimination between benign and malignant uterine disease.

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“…15 A cost-effectiveness analysis of this technique revealed the cost to prevent a single case of disseminated malignancy was a little more than $10.5 million. 16 A number of surgeons, recognizing the potential benefit of minimally invasive approaches and cognizant of the risk of potentially upstaging a malignancy, are researching innovative ways to morcellate in contained spaces. Regardless, the road ahead has already been forever altered as a result of lay press coverage of what we as physicians choose as part of our surgical armamentarium.…”

Section: Power Morecellatorsmentioning

confidence: 99%

The Role of Social Networks, Medical–Legal Climate, and Patient Advocacy on Surgical Options

Tracy

Bortoletto

2016

Obstetrics &Amp; Gynecology

Self Cite

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The dissemination of information online and resultant public discourse through social media and other online channels has influenced the practice of medicine in dramatic ways. Physicians have historically worked to develop new techniques and devices for the benefit of their patients. It is only a more recent phenomenon, however, that these tools are either removed or their use is curtailed largely driven by anecdotal reports; passionate, vocal, often media-savvy advocates; and plaintiff attorneys. The use of power morcellation, hysteroscopic tubal sterilization, and mesh in urogynecologic procedures all have been victims of these societal pressures. It is important for health care professionals to be involved in the debate to ensure that public outcry does not unduly influence what we, as clinicians, are able to safely offer our patients. By being better advocates for our field, our instruments, and our patients, we can ensure medical decision-making is driven by good science and not public fervor.

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Cost-Effectiveness Analysis of Morcellation Hysterectomy for Myomas

Cited by 23 publications

References 47 publications

MRI screening for uterine leiomyosarcoma

MRI screening for uterine leiomyosarcoma

Risk of Occult Uterine Sarcoma in Presumed Uterine Fibroids

The Role of Social Networks, Medical–Legal Climate, and Patient Advocacy on Surgical Options

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