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Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MRgHIFU) for
Treatment of Symptomatic Uterine Fibroids: An Economic Analysis
#MMPMID26357531
Babashov V
; Palimaka S
; Blackhouse G
; O'Reilly D
Ont Health Technol Assess Ser
2015[]; 15
(5
): 1-61
PMID26357531
show ga
BACKGROUND: Uterine fibroids, or leiomyomas, are the most common benign tumours
in women of childbearing age. Some women experience symptoms (e.g., heavy
bleeding) that require aggressive forms of treatment such as uterine artery
embolization (UAE), myomectomy, magnetic resonance-guided high-intensity focused
ultrasound (MRgHIFU), and even hysterectomy. It is important to note that
hysterectomy is not appropriate for women who desire future childbearing.
OBJECTIVES: The objective of this analysis was to evaluate the cost-effectiveness
and budgetary impact of implementing MRgHIFU as a treatment option for
symptomatic uterine fibroids in premenopausal women for whom drugs have been
ineffective. REVIEW METHODS: We performed an original cost-effectiveness analysis
to assess the long-term costs and effects of MRgHIFU compared with hysterectomy,
myomectomy, and UAE as a strategy for treating symptomatic uterine fibroids in
premenopausal women aged 40 to 51 years. We explored a number of scenarios, e.g.,
comparing MRgHIFU with uterine-preserving procedures only, considering
MRgHIFU-eligible patients only, and eliminating UAE as a treatment option. In
addition, we performed a one-year budget impact analysis, using data from Ontario
administrative sources. Four scenarios were explored in the budgetary impact
analysis: ?MRgHIFU funded at 2 centres ?MRgHIFU funded at 2 centres and replacing
only uterine-preserving procedures ?MRgHIFU funded at 6 centres ?MRgHIFU funded
at 6 centres and replacing only uterine-preserving procedures Analyses were
conducted from the Ontario public payer perspective. RESULTS: The base case
determined that the uterine artery embolization (UAE) treatment strategy was the
cost-effective option at commonly accepted willingness-to-pay values. Compared
with hysterectomy, UAE was calculated as having an incremental cost-effectiveness
ratio (ICER) of $46,480 per quality-adjusted life-year (QALY) gained. The MRgHIFU
strategy was extendedly dominated by a combination of UAE and hysterectomy, and
myomectomy was strictly dominated by MRgHIFU and UAE. In the scenario where only
MRgHIFU-eligible patients were considered, MRgHIFU was the cost-effective option
for a willingness-to-pay threshold of $50,000. In the scenario where only
MRgHIFU-eligible patients were considered and where UAE was eliminated as a
treatment option (due to its low historic utilization in Ontario), MRgHIFU was
cost-effective with an incremental cost of $39,250 per additional QALY. The
budgetary impact of funding MRgHIFU for treatment of symptomatic uterine fibroids
was estimated at $1.38 million in savings when funded to replace all types of
procedures at 2 centres, and $1.14 million when funded to replace only
uterine-preserving procedures at 2 centres. The potential savings increase to
$4.15 million when MRgHIFU is funded at 6 centres to treat all women eligible for
the procedure. Potential savings at 6 centres decrease slightly, to $3.42
million, when MRgHIFU is funded to replace uterine-preserving procedures only.
CONCLUSIONS: Our findings suggest that MRgHIFU may be a cost-effective strategy
at commonly accepted willingness-to-pay thresholds, after examining the
uncertainty in model parameters and several likely scenarios. In terms of budget
impact, the implementation of MRgHIFU could potentially result in one-year
savings of $1.38 million and $4.15 million in the scenarios where MRgHIFU is
implemented in 2 or 6 centres, respectively. From a patient perspective, it is
important to consider that MRgHIFU is the least invasive of all fibroid treatment
options for women who have not responded to pharmaceuticals; it is the only one
that is completely noninvasive. Also important, from a societal point of view, is
the potential benefit from faster recovery times. Despite these benefits,
implementation of MRgHIFU beyond the 2 centres which currently offer the
treatment faces logistical challenges (for example, competing demands for use of
existing equipment), as well as financial challenges, with hospitals needing to
fundraise to purchase new equipment.
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