Economic Evaluation of Uterine Artery Embolization versus Hysterectomy in the Treatment of Symptomatic Uterine Fibroids: Results from the Randomized EMMY Trial
Received 17 October 2007; received in revised form 3 March 2008; accepted 3 March 2008.
Purpose
To investigate whether uterine artery embolization (UAE) is a cost-effective alternative to hysterectomy for patients with symptomatic uterine fibroids, the authors performed an economic evaluation alongside the multicenter randomized EMMY (EMbolization versus hysterectoMY) trial.
Materials and Methods
Between February 2002 and February 2004, 177 patients were randomized to undergo UAE (n = 88) or hysterectomy (n = 89) and followed up until 24 months after initial treatment allocation. Conditional on the equivalence of clinical outcome, a cost minimization analysis was performed according to the intention to treat principle. Costs included health care costs inside and outside the hospital as well as costs related to absence from work (societal perspective). Cumulative standardized costs were estimated as volumes multiplied with prices. The nonparametric bootstrap method was used to quantify differences in mean (95% confidence interval [CI]) costs between the strategies.
Results
In total, 81 patients underwent UAE and 75 underwent hysterectomy. In the UAE group, 19 patients (23%) underwent secondary hysterectomies. The mean total costs per patient in the UAE group were significantly lower than those in the hysterectomy group ($11,626 vs $18,563; mean difference, −$6,936 [−37%], 95% CI: −$9,548, $4,281). The direct medical in-hospital costs were significantly lower in the UAE group: $6,688 vs $8,313 (mean difference, −$1,624 [−20%], 95% CI: −$2,605, −$586). Direct medical out-of-hospital and direct nonmedical costs were low in both groups (mean cost difference, $156 in favor of hysterectomy). The costs related to absence from work differed significantly between the treatment strategies in favor of UAE (mean difference, −$5,453; 95% CI: −$7,718, −$3,107). The costs of absence from work accounted for 79% of the difference in total costs.
Conclusions
The 24-month cumulative cost of UAE is lower than that of hysterectomy. From a societal economic perspective, UAE is the superior treatment strategy in women with symptomatic uterine fibroids.
aDepartment of Radiology, Academic Medical Centre, G1-235, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
bDepartment of Gynaecology, Academic Medical Centre, G1-235, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
cFaculty of Medicine, Academic Medical Centre, G1-235, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
dDepartment of Public Health Epidemiology, Academic Medical Centre, G1-235, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
eErasmus Medical Centre, Institute of Health Policy and Management.
Address correspondence to N.A.V.
The EMMY study is funded by ZonMw 'Netherlands Organisation for Health Research and Development' (grant application number 945-01-017) and supported by Boston Scientific Corporation, The Netherlands.
None of the authors have identified a conflict of interest.
ABSTRACT