Skip to main content

Cost-effectiveness of magnetic resonance guided focused ultrasound for the treatment of uterine fibroids

  • Amy K. O'Sullivan (a1), David Thompson (a1), Paula Chu (a1), David W. Lee (a2), Elizabeth A. Stewart (a3) and Milton C. Weinstein (a4)...

Objectives: The aim of this study is to evaluate the cost-effectiveness of Magnetic Resonance Guided Focused Ultrasound (MRgFUS) compared with alternative treatments for uterine fibroids in the United States.

Methods: We used techniques of decision analysis and data from secondary sources to develop and estimate an economic model of the management of uterine fibroids among premenopausal women. Patients in the model receive treatment with MRgFUS, uterine artery embolization (UAE), abdominal myomectomy, hysterectomy, or pharmacotherapy. The model predicts total costs (including subsequent procedures) and quality-adjusted life-years (QALYs) for each treatment strategy over a lifetime horizon, discounted at 3 percent, from a societal perspective. Data on treatment efficacy and safety were obtained from published and unpublished studies. Costs (2005 US$) were obtained from an analysis of a large administrative database and other secondary sources. Lost productivity costs were included in the base-case analysis, but excluded in a sensitivity analysis.

Results: UAE was associated with the most QALYs (17.39), followed by MRgFUS (17.36), myomectomy (17.31), hysterectomy (17.18), and pharmacotherapy (16.70). Pharmacotherapy was the least costly strategy ($9,200 per patient), followed by hysterectomy ($19,800), MRgFUS ($27,300), UAE ($28,900), and myomectomy ($35,100). Incremental cost-effectiveness ratios (cost per QALY gained) were $21,800 for hysterectomy, $41,400 for MRgFUS, and $54,200 for UAE; myomectomy was more costly and less effective than both MRgFUS and UAE. Results were sensitive to MRgFUS recurrence rates, MRgFUS procedure costs, and assumptions about quality of life following hysterectomy.

Conclusions: Our findings suggest that MRgFUS is in the range of currently accepted criteria for cost-effectiveness, along with hysterectomy and UAE.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Cost-effectiveness of magnetic resonance guided focused ultrasound for the treatment of uterine fibroids
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Cost-effectiveness of magnetic resonance guided focused ultrasound for the treatment of uterine fibroids
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Cost-effectiveness of magnetic resonance guided focused ultrasound for the treatment of uterine fibroids
      Available formats
Hide All
1. Agency for Healthcare Research and Quality (AHRQ). Evidence Report No. 34. Management of uterine fibroids volume 1. January 2001. Accessed April 5, 2006.
2. American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin. Number 16. Surgical alternatives to hysterectomy in the management of leiomyomas. Washington, DC: American College of Obstetricians and Gynecologists; 2000.
3. Arleo EK, Khilnani NM, Ng A, Min RJ. Features influencing patient selection for fibroid treatment with magnetic resonance-guided focused ultrasound. J Vasc Interv Radiol. 2007;18:681685.
4. Beinfeld MT, Bosch JL, Gazelle GS. Hospital costs of uterine artery embolization and hysterectomy for uterine fibroid tumors. Acad Radiol. 2002;9:13001304.
5. Beinfeld MT, Bosch JL, Isaacson KB, Gazelle GS. Cost-effectiveness of uterine artery embolization and hysterectomy for uterine fibroids. Radiology. 2004;230:207213.
6. Blue Cross and Blue Shield Association (BCBS). Uterine artery embolization for treatment of symptomatic uterine fibroids. 2002;17:120.
7. Brahma PK, Martel KM, Christman GM. Future directions in myoma research. Obstet Gynecol Clin. 2006;33:199244.
8. Carls GS, Lee DW, Ozminkowski RJ, et al. What are the total costs of surgical treatment for uterine fibroids? J Womens Health. 2008;17:11191132.
9. Cura M, Cura A, Bugnone A. Role of magnetic resonance imaging in patient selection for uterine artery embolization. Acta Radiol. 2006;47:11051114.
10. Dembek CJ, Pelletier EM, Isaacson KB, Spies JB. Payer costs in patients undergoing uterine artery embolization, hysterectomy, or myomectomy for treatment of uterine fibroids. J Vasc Interv Radiol. 2007;18:12071213.
11. Dicker RC, Greenspan JR, Strauss LT, et al. Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States: The collaborative review of sterilization. Am J Obstret Gynecol. 1982;144:841848.
12. Drug Topics Redbook 2006. Montvale NJ: Thompson PDR; 2006.
13. Ecker JL, Foster JT, Friedman AJ. Abdominal hysterectomy or abdominal myomectomy for symptomatic leiomyoma: A comparison of preoperative demography and postoperative morbidity. J Gynecol Surg. 1995;11:1118.
14. Fennessy FM, Tempany CM, McDannold NJ, et al. Uterine leiomyomas: MR imaging-guided focused ultrasound surgery-Results of different treatment protocols. Radiology. 2007;243:885893.
15. Flynn M, Jamison M, Datta S, Myers E. Health care resource use for uterine fibroid tumors in the United States. Am J Obstet Gynecol. 2006;195:955964.
16. Gavrilova-Jordan LP, Rose CH, Traynor KD, et al. Successful term pregnancy following MR-guided focused ultrasound treatment of uterine leiomyoma. J Perinatol. 2007;27:5961.
17. Gold MR, Siegel JE, Russell LB, Weinstein MC, eds. Cost-effectiveness in health and medicine. New York, NY: Oxford University Press, Inc; 1996.
18. Goldberg J, Bussard A, McNeil J, Diamond J. Cost and reimbursement for three fibroid treatments: Abdominal hysterectomy, abdominal myomectomy, and uterine fibroid embolization. Cardiovasc Intervent Radiol. 2007;30:5458.
19. Gupta J, Sinha A, Lumsden M, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 2006;1:CD005073.
20. Hartmann KE, Birnbaum H, Ben-Hamadi R, et al. Annual costs associated with diagnosis of uterine leiomyomata. Obstet Gynecol. 2006;108:930937.
21. Hesley GK, Felmlee JP, Gebhart JB, et al. Noninvasive treatment of uterine fibroids: Early Mayo experience with magnetic resonance imaging-guided focused ultrasound. Mayo Clin Proc 2006;81:936942.
22. InSightec. Report to the FDA, December 2006.
23. Iverson RE Jr, Chelmow D, Strohbehn K, et al. Relative morbidity of abdominal hysterectomy and myomectomy for management of uterine leiomyomas. Obstet Gynecol. 1996;88:415419.
24. Mauskopf J, Flynn M, Thieda P, et al. The economic impact of uterine fibroids in the United States: A summary of published estimates. J Womens Health. 2005;14:692703.
25. Morita Y, Ito N, Ohashi H. Pregnancy following MR-guided focused ultrasound surgery for a uterine fibroid. Int J Gynaecol Obstet. 2007;99:5657.
26. Oderda G, Asche C, Jones KP, et al. Characterization of therapy and costs for patients with uterine fibroids in Utah Medicaid. Arch Gynecol Obstet. 2007;276:211218.
27. Pelage JP, Le Dref O, Soyer P, et al. Fibroid-related menorrhagia: Treatment with superselective embolization of the uterine arteries and midterm follow-up. Radiology. 2000;215:428431.
28. Rannestad T. Hysterectomy: Effects on quality of life and psychological aspects. Best Pract Res Clin Obstet Gynaecol. 2005;19:419430.
29. Reed SD, Newton KM, Thompson LB, et al. The incidence of repeat uterine surgery following myomectomy. J Womens Health. 2006;15:10461052.
30. Smart OC, Hindley JT, Regan L, Gedroyc W. Gonadotrophin-releasing hormone and magnetic-resonance-guided ultrasound surgery for uterine leiomyomata. Obstet Gynecol. 2006;108:4954.
31. Smith SJ. Uterine fibroid embolization. Am Fam Physician. 2000;61:36013607.
32. Spies JB, Ascher SA, Roth AR, et al. Uterine artery embolization for leiomyomata. Obstet Gynecol. 2001;98:2934.
33. Spies JB, Bruno J, Czeyda-Pommersheim F, et al. Long-term outcome of uterine artery embolization of leiomyomata. Obstet Gynecol. 2005;106:933939.
34. Spies JB, Cooper JM, Worthington-Kirsch R, et al. Outcome of uterine embolization and hysterectomy for leiomyomas: Results of a multicenter study. Am J Obstet Gynecol. 2004;191:2231.
35. Stewart EA, Gostout B, Rabinovici J, et al. Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol. 2007;110:279287.
36. Stewart EA, Rabinovici J, Tempany CM, et al. Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids. Fertil Steril. 2006;85:2229.
37. Subramanian S, Clark MA, Isaacson K. Outcome and resource use associated with myomectomy. Obstet Gynecol. 2001;98:583587.
38. Sullivan PW, Lawrence WF, Ghushchyan V. Preference-based EQ-5D index scores for chronic conditions in the United States. Med Decis Making. 2006;26:410420.
39. Toaff ME. Why would a woman resist hysterectomy. Accessed May 2007.
40. U.S. Bureau of Labor Statistics. Usual Weekly Earnings of Wage and Salary Workers: First Quarter 2006. Accessed September 2006.
41. Volkers NA, Hehenkamp WJK, Birnie E, et al. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years' outcome from the randomized EMMY trial. Am J Obstet Gynecol. 2007;196:519e1519e11.
42. Walker CL, Stewart EA. Uterine fibroids: The elephant in the room. Science 2005;308:15891592.
43. Zowall H, Carins JA, Brewer C, et al. Cost-effectiveness of magnetic resonance-guided focused ultrasound surgery for the treatment of uterine fibroids. BJOG. 2008;115:653662.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 6
Total number of PDF views: 214 *
Loading metrics...

Abstract views

Total abstract views: 222 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 20th November 2017. This data will be updated every 24 hours.