MRI-guided focused ultrasound surgery for uterine fibroid treatment: a cost-effectiveness analysis.
MRI-guided focused ultrasound surgery for uterine fibroid treatment: a cost-effectiveness analysis.
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DOI：
10.2214/ajr.13.11446
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发表时间：
2014-08
期刊：
影响因子：
--
通讯作者：
Fennessy FM
中科院分区：
文献类型：
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作者：
Kong CY;Meng L;Omer ZB;Swan JS;Srouji S;Gazelle GS;Fennessy FM
为了评估使用磁共振引导聚焦超声（MRgFUS）作为一线治疗方法相对于子宫动脉栓塞（UAE）或腹式子宫切除术（HYST）治疗症状性子宫肌瘤的成本-效果。我们开发了一个决策分析模型来比较三种治疗策略的成本效益：MRgFUS， UAE和HYST。每种治疗方法的短期和长期效用都被纳入其中，使我们能够考虑到所考虑的策略在生活质量上的差异。计算了每种策略的生命周期成本和质量调整生命年（QALYs）。进行了增量成本效益分析，使用每个QALY 50,000美元的社会支付意愿（WTP）阈值来指定具有成本效益的策略。对所有关键模型参数进行敏感性分析。在基本病例分析中，症状性肌瘤的治疗始于40岁，阿联酋是最有效和最昂贵的策略（22.81 QALYs， 22164美元），其次是MRgFUS （22.80 QALYs, 19,796美元）和HYST （22.60 QALYs, 13,291美元）。MRgFUS相对于HYST具有成本效益，相关的增量成本效益比（ICER）为33,110美元/QALY。相对于阿联酋而言，MRgFUS也具有成本效益——阿联酋相对于MRgFUS的ICER（270,057美元）远远超过WTP门槛（50,000美元/QALY）。在敏感性分析中，结果对大多数参数的变化是稳健的，但对某些手术后复发概率和症状缓解的变化以及与症状性肌瘤相关的生活质量的变化是敏感的。MRgFUS相对于UAE和子宫切除术治疗有症状的女性肌瘤具有成本效益。
To evaluate the cost-effectiveness of a treatment strategy for symptomatic uterine fibroids that employs Magnetic Resonance guided Focused Ultrasound (MRgFUS) as a first-line therapy relative to uterine artery embolization (UAE) or abdominal hysterectomy (HYST). We developed a decision-analytic model to compare the cost-effectiveness of three treatment strategies: MRgFUS, UAE and HYST. Short and long-term utilities specific to each treatment were incorporated, allowing us to account for differences in quality of life across the strategies considered. Lifetime costs and quality-adjusted life-years (QALYs) were calculated for each strategy. An incremental cost-effectiveness analysis was performed, using a societal willingness-to-pay (WTP) threshold of $50,000 per QALY to designate a strategy as cost-effective. Sensitivity analysis was performed on all key model parameters. In the base-case analysis, in which treatment for symptomatic fibroids started at age 40, UAE was the most effective and expensive strategy (22.81 QALYs, $22,164), followed by MRgFUS (22.80 QALYs, $19,796) and HYST (22.60 QALYs, $13,291). MRgFUS was cost-effective relative to HYST, with an associated incremental cost-effectiveness ratio (ICER) of $33,110/QALY. MRgFUS was also cost-effective relative to UAE – the ICER of UAE relative to MRgFUS ($270,057) far exceeded the WTP threshold of $50,000/QALY. In sensitivity analysis, results were robust to changes in most parameters, but were sensitive to changes in probabilities of recurrence and symptom relief following certain procedures, and quality of life associated with symptomatic fibroids. MRgFUS is cost-effective relative to both UAE and hysterectomy for the treatment of women with symptomatic fibroids.