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

ObjectiveTo compare the cost and quality-adjusted life-years (QALYs) of hysterectomy, myomectomy, and uterine artery embolization (UAE) for symptomatic control of uterine fibroids.DesignA cost-utility analysis conducted by using Markov modeling.SettingThe 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.