OBJECTIVES: To determine the cost-effectiveness of different treatment options and optimal number of treatments for symptomatic uterine fibroids among premenopausal women who would prefer to retain uterus.
METHODS: A Markov model with a 1-year cycle length was developed. Women entered the model at diagnosis with symptomatic fibroids and were followed to menopause or age 60 years, when all women were assumed to reach menopause. Treatment options included watchful waiting, myomectomy, and one-time, 6-month use of gonadotropin-releasing hormone (GnRH). In the model, women treated unsuccessfully or whose symptoms recurred could undergo up to three additional treatments or stop treatment at any point. Data on treatment efficacy, quality-of-life, and medical costs (2007 US$) were from published studies. For myomectomy, the probabilities of repeat procedures and of emergency hysterectomy were from a large US claims database analysis. Age-specific rates for pregnancy and menopause were based on US data. Total costs and quality-adjusted life years (QALYs), discounted annually at 3%, were calculated for each treatment strategy for women diagnosed at different ages. Incremental cost-effectiveness ratios (ICERs) were calculated and an efficiency frontier was plotted.
RESULTS: Base-case results for women diagnosed at age 20 years showed treatment strategies including GnRH were dominant compared with treatment strategies including myomectomy only and were cost-effective compared with watchful waiting (ICER range: $3789- $7456 per QALY gained). Additional procedures for women whose symptoms recurred led to increased medical costs and QALYs, resulting in an incremental cost per QALY gained of $13,307, $15,433, and $17,555 for the second, third, and fourth myomectomy, respectively. Results were sensitive to age at diagnosis, number of treatments, and the disutility associated with a woman losing her uterus via emergency hysterectomy.
CONCLUSIONS: This model is the first to assess the cost-effectiveness and optimal number of treatments specifically for a woman with fibroids seeking to retain her uterus.
