Is Pre-Assisted Reproductive Technology (ART) Hysteroscopic Myomectomy (HM) Cost-Effective (CE) in Women with Submucous (SM) Fibroids?

Friday, November 08, 2013 — Poster Session III
10:00 a.m. – 12:00 p.m.	FAES Academic Center (Upper-Level Terrace)	NICHD	CLIN-8

Authors

K Devine
S Mumford
J Segars
AY Armstrong

Abstract

OBJECTIVE: To determine whether removal of SM fibroids prior to ART was CE. DESIGN: Decision tree model MATERIALS AND METHODS: PubMed search determined: (1) likelihood of ongoing ART pregnancy (OPR) with SM fibroids in situ vs. post-HM; and (2) mean perioperative costs of HM. ART charges from regionally diverse clinic websites were adjusted to 2012 dollars and used as surrogates for clinical costs. Median ART and median HM+ART costs were $14,728 and $21,710, respectively. Decision tree compared: (1) ART vs. (2) HM followed by ART. Sensitivity analyses were performed over the range of OPRs. RESULTS: ART success (OPR) in patients with SM fibroids in situ vs. post-HM were obtained from three published studies as 18.5%-35.0% and 33.9%-61.0%, respectively. Sensitivity analyses determined that pre-ART HM was CE when cost per ongoing pregnancy in the no-surgery group was >$64,034, i.e. when OPR among women with in situ SM myomas was <23.0%. HM was also CE whenever post-HM OPR was >51.6%, which brought cost per ongoing post-HM pregnancy to <$42,079. Therefore, an improvement in OPR of 10.9% (23% pre-HM vs. 33.9% post-HM) was required to make pre-ART HMcost-effective. CONCLUSION: These findings confirm a cost benefit for patients with SM myoma(s) pursuing ART.