Is Pre-Assisted Reproductive Technolgy (ART) Myomectomy Cost-Effective (CE) In Women with Intramural (IM) Fibroids?

Friday, November 08, 2013 — Poster Session III
10:00 a.m. – 12:00 p.m.	FAES Academic Center (Upper-Level Terrace)	NICHD	CLIN-7

Authors

K Devine
M Egbuniwe
S Mumford
AY Armstrong

Abstract

Objective: To determine whether myomectomy for IM fibroids prior to ART lowers cost/ongoing pregnancy. Design: Decision tree model Methods: PubMed search determined: (1) likelihood of ART ongoing pregnancy (OPR) in patients with IM fibroids in situ vs. post-abdominal (AM) and laparoscopic myomectomy (LM); and (2) mean perioperative costs (surgery and hospital stay) of AM and LM. Adjusted to 2012 dollars and used as surrogates for clinical costs, mean ART charges from clinic websites were $15,223. Mean AM+ART and LM+ART charges were $23,381 and $25,676, respectively. Sensitivity analyses were performed over the range of OPRs. Results: OPR with IM fibroids in situ vs. post-myomectomy from four published studies were 18.5%-35.0% (in situ) vs. 33.9%-52% (AM) and 25%-86% (LM). Sensitivity analyses determined that pre-ART AM was CE when cost/ongoing pregnancy was >$68,971 (i.e. when OPR among women with in situ myomas was /=33.9% (cost/OP/= 11.9%. LM was only CE when it increased OPR to >59.0%, which though reported, is significantly above the national mean. Conclusions: From a cost perspective, surgery for IM fibroids prior to ART should be undertaken only when perceived detriment is great and expected postoperative outcome is excellent.