MRI-guided fibroid surgery preferred over alternatives

First-line treatment of uterine fibroids with MRI-guided focused ultrasound is a cost-effective noninvasive strategy, according to a study published in the August issue of the American Journal of Roentgenology.

Authors Chung Y. Kong, of Massachusetts General Hospital and the Harvard Medical School, and colleagues, wrote that the cost of about $20,000 for MRI-guided fibroid surgery was lower than roughly $23,000 for uterine artery embolization (UAE). Both procedures were about double the roughly $11,000 cost of hysterectomy, the oldest and most widely used procedure, they said. The FDA approved the MRI-guided surgery in 2004, and UAE in 1995.

Although the cost of a hysterectomy is less when measured in dollars alone, it carries a heavy psychological load, the authors noted. Additionally, hysterectomy can include more surgical complications than MRI-guided surgery, which is an out-patient procedure.

“Added onto the monetary cost of hysterectomy … is the psychological burden of uterine removal for a benign disease, particularly for younger women who may have wanted to preserve their fertility,” wrote Kong and colleagues.

“This has resulted in the emergence of a spectrum of nonsurgical and less-invasive options for fibroids, including [UAE], and, more recently, MRI-guided focused ultra-sound surgery.”

Although there were no comparable figures for MRI-guided surgery, the authors found that fibroids accounted for roughly 50 percent of the half-million hysterectomies performed in 2005 in the U.S., at a cost of around $2 billion.

The researchers included the cost of surgical complications in their analysis. For example, the cost of injuries to the bladder, bowel and ureter were included for complications of laparoscopic and abdominal hysterectomies. These costs included the amount paid to hospitals, physicians, and the estimated cost of lost productivity for the patient.

The researchers also measured the quality of life resulting for patients from the procedures. Less invasive procedures had a quantifiable positive impact, the study found. For example, the number of quality-adjusted life years for patients undergoing the MRI-guided fibroid surgery was 0.188 years, compared to 0.012 years for UAE.

For those patients who are eligible, depending on the number and location of fibroids, the authors recommend MRI-guided fibroid surgery.

“Our analysis shows that, as a first-line treatment of eligible patients with symptomatic uterine fibroids, MRI-guided focused ultrasound is preferred to both UAE and hysterectomy as a cost-effective strategy,” they wrote.