Uterine artery embolisation or hysterectomy for the treatment of symptomatic uterine fibroids: a cost-utility analysis of the HOPEFUL study O Wu, a A Briggs, a S Dutton, b,c A Hirst, c M Maresh, d A Nicholson, e K McPherson c a Public Health and Health Policy, Division of Community Based Sciences, University of Glasgow, Glasgow, UK b Centre for Statistics in Medicine and c Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK d Department of Obstetrics and Gynaecology, St Mary’s Hospital for Women and Children, Manchester, UK e Department of Radiology, Leeds General Infirmary, Leeds, UK Correspondence: Dr O Wu, Public Health and Health Policy, Division of Community Based Sciences, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK. Email o.wu@clinmed.gla.ac.uk Accepted 19 June 2007. Objectives To evaluate the relative cost-effectiveness of uterine artery embolisation (UAE) and hysterectomy in women with symptomatic uterine fibroids from the perspective of the UK NHS. Design Cost-utility analysis. Setting Eighteen UK NHS hospital trusts. Population or sample Women who underwent UAE (n = 649; average follow up of 8.6 years) or hysterectomy (n = 459; average follow up of 4.6 years) for the treatments of symptomatic fibroids. Methods A probabilistic decision model was carried out based on data from a large comparative cohort and the literature. The two interventions were evaluated over the time horizon from the initial procedure to menopause. Extensive sensitivity analysis was carried out to test model assumptions and parameter uncertainties. Main outcome measures Costs of procedures and complications and quality of life expressed as quality-adjusted life years (QALYs). Results Overall, UAE was associated with lower mean cost (£2536 versus £3282) and a small reduction in quality of life (8.203 versus 8.241 QALYs) when compared with hysterectomy. However, when the quality of life associated with the conservation of the uterus was incorporated in the model, UAE was shown to be the dominant strategy—lower costs and greater QALYs. Conclusions UAE is a less expensive option to the health service compared with hysterectomy, even when the costs of repeat procedures and associated complications are factored in. The quality of life implications in the short term are also predicted to favour UAE; however, this advantage may be eroded over time as women undergo additional procedures to deal with recurrent fibroids. Given the hysterectomy is the current standard treatment for symptomatic fibroids, offering women UAE as an alternative treatment for fibroids is likely to be highly cost-effective for those women who prefer uterus-conserving treatment. Keywords Cost-utility analysis, hysterectomy, uterine artery embolisation. Please cite this paper as: Wu O, Briggs A, Dutton S, Hirst A, Maresh M, Nicholson A, McPherson K. Uterine artery embolisation or hysterectomy for the treatment of symptomatic uterine fibroids: a cost-utility analysis of the HOPEFUL study. BJOG 2007;114:1352–1362. Introduction Uterine artery embolisation (UAE) is a new technique that has been approved by the National Institute for Clinical Excellence (NICE) for the treatment of uterine fibroids and relieving symptoms. 1 However, although the uterus is con- served, fibroids are rendered avascular and not removed. Therefore, complete symptom resolution cannot be guaran- teed, and in some instances, additional procedures such as repeat UAE, myomectomy or hysterectomy may be required subsequently due to unresolved or recurrent symptoms. Hys- terectomy is the gold standard by which other treatments should be assessed because it removes the source of the symp- toms. In addition to efficacy, the two procedures differ sub- stantially with regards to treatment-associated complications, time to recovery, resource use and quality of life. These factors need to be taken into account when making decisions on the choice of treatment. Compared with hysterectomy, UAE is a minimally invasive procedure. It is performed under local anaesthetic and, on average, requires an overnight hospital stay and up to 4 weeks of recovery time. However, in some UAE cases, technical 1352 ª 2007 The Authors Journal compilation ª RCOG 2007 BJOG An International Journal of Obstetrics and Gynaecology DOI: 10.1111/j.1471-0528.2007.01525.x www.blackwellpublishing.com/bjog General gynaecology