Economic Evaluation of Uterine Artery Embolization versus Hysterectomy in the Treatment of Symptomatic Uterine Fibroids: Results from the Randomized EMMY Trial Nicole A. Volkers, MD, PhD, Wouter J.K. Hehenkamp, MD, PhD, Patrick Smit, MSc, Willem M. Ankum, MD, PhD, Jim A. Reekers, MD, PhD, and Erwin Birnie, PhD 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. J Vasc Interv Radiol 2008; 19:1007–1017 Abbreviations: CI = confidence interval, EMMY = EMbolization versus hysterectoMY, EuroQOL 5 = EuroQOL 5 dimension 3 level version, HUI-3 = Health Utilities Index Mark 3, MOS SF-36 = Medical Outcome Study Short Form 36, UAE = uterine artery embolization UTERINE fibroids are benign tumors arising from smooth muscle cells of the uterine wall. Fibroids are clinically apparent in approximately 25% of women of reproductive age and are found in approximately 77% of surgi- cally excised uteri at histopathologic examination (1). Fibroids may cause several symptoms (eg, menorrhagia, pain, and bulk-related complaints) that may compromise women’s health status. For symptomatic uterine fi- broids, a wide variety of both medical and surgical treatment options are available (1). Hysterectomy is the final option whenever other treatments (eg, pharmaceutical treatment or myomec- tomy) are either unsuitable or ineffec- From the Department of Radiology (N.A.V., J.A.R.), Department of Gynaecology (W.J.K.H., W.M.A.), Faculty of Medicine (P.M.S.), and Department of Public Health Epidemiology (E.B.), Academic Med- ical Centre, G1-235, Meibergdreef 9, 1105 AZ Am- sterdam, The Netherlands; and Erasmus Medical Centre, Institute of Health Policy and Management (E.B.). Received October 17, 2007; final revision re- ceived March 3, 2008; accepted March 3, 2008. Ad- dress correspondence to N.A.V.; E-mail: n.a.volkers@ amc.uva.nl The EMMY study is funded by ZonMw ’Nether- lands Organisation for Health Research and Devel- opment’ (grant application number 945-01-017) and supported by Boston Scientific Corporation, The Netherlands. None of the authors have identified a conflict of interest. © SIR, 2008 DOI: 10.1016/j.jvir.2008.03.001 1007