Uterine artery embolisation or myomectomy for women with uterine fibroids wishing to avoid hysterectomy: a cost–utility analysis of the FEMME trial

Abstract

To assess the cost-effectiveness of uterine artery embolization (UAE) and myomectomy for women with symptomatic uterine fibroids wishing to avoid hysterectomy. DesignEconomic evaluation alongside the FEMME randomised controlled trial. Setting UK hospitals. PopulationPremenopausal 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). MethodsA within trial cost-utility analysis was conducted from the perspective of the UK NHS. Main outcome measuresQuality-adjusted life years measured using the EuroQoL 3L, combined with costs to estimate cost-effectiveness over two and four years of follow-up. ResultsOver 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

Effects on heavy menstrual bleeding and pregnancy of uterine artery embolization (UAE) or myomectomy for women with uterine fibroids wishing to avoid hysterectomy: The FEMME randomized controlled trial

“…The data from the present study showed that myomectomy was cost‐effective in the UK healthcare setting 24 ; however, this does not take into account that UAE is less invasive. Given that both procedures are clinically effective, UAE may be more attractive in low‐resource settings as it requires a shorter hospital stay (median 4 days compared with 2 days) and has the potential to be completed as an outpatient procedure.…”

Uterine artery embolization or myomectomy for women with uterine fibroids: Four-year follow-up of a randomised controlled trial

“…A cost-utility assessment of the two procedures based on the FEMME trial has been published elsewhere. [15] UAE is dominated by myomectomy and would not be considered a cost-effective alternative over myomectomy, but this does not take into account any potential preference for a less invasive procedure. There is such a small difference in costs between the two procedures, fully informed patient preference should be acknowledged, and women should have the option to choose between the two procedures.…”

Evidences in Uterine Artery Embolization: A Radiologist's Primer

“…The recent FEMME trial that evaluated the cost utility of myomectomy versus UAE showed UAE to be associated with higher costs (difference of 645 pounds) in 4 year horizon 9 These results point out that the short-term results of UAE are good, while the long-term results of myomectomy are better, as UAE may require frequent reinterventions.…”