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

Rana, D. et al. (2021) Uterine artery embolization or myomectomy for women with uterine fibroids wishing to avoid hysterectomy: a cost-utility analysis of the FEMME trial. BJOG: An International Journal of Obstetrics and Gynaecology, 128(11), pp. 1793-1802. (doi: 10.1111/1471-0528.16781) (PMID:34053154)

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Abstract

Objectives: To assess the cost-effectiveness of uterine artery embolization (UAE) and myomectomy for women with symptomatic uterine fibroids wishing to avoid hysterectomy. Design: Economic evaluation alongside the FEMME randomised controlled trial. Setting: 29 UK hospitals. Population: Premenopausal 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). Methods: A within trial cost-utility analysis was conducted from the perspective of the UK NHS. Main outcome measures: Quality-adjusted life years measured using the EuroQoL 3L, combined with costs to estimate cost-effectiveness over two and four years of follow-up. Results: Over 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 associated with higher costs (difference £456; 95% CI -1,823; 3,164) and lower QALYs (difference -0.06; 95% CI (-0.11; -0.02). Conclusions: Myomectomy is a cost-effective option for the treatment of uterine fibroids. The differences in costs and quality-adjusted life years are small. Women should be fully informed and have the option to choose between the two procedures.

Item Type:Articles
Additional Information:Funding: National Institute of Health Research (NIHR) Health Technology Assessment programme reference number 08/53/22.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Moss, Professor Jonathan and Wu, Professor Olivia and Rana, Miss Dikshyanta
Authors: Rana, D., Wu, O., Cheed, V., Middleton, L. J., Moss, J., Lumsden, M. A., McKinnon, W., Daniels, J., Sirkeci, F., Manyonda, I., Belli, A.-M., and McPherson, K.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
Journal Name:BJOG: An International Journal of Obstetrics and Gynaecology
Publisher:Wiley
ISSN:1470-0328
ISSN (Online):1471-0528
Published Online:30 May 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in BJOG: An International Journal of Obstetrics and Gynaecology 128(11): 1793-1802
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
166286A prospective randomised trial of myomectomy versus uterine artery embolisation (UAE) for women with uterine fibroids who wish to retain or improve their fertility (FEMME)Mary LumsdenNational Institute for Health Research (NIHR)08/53/22Med - Life course Nutrition and Health