Fiona Mary Fennessy MD, Presenter: Nothing to Disclose

Clare M.C. Tempany-Afdhal MD, Abstract Co-Author: Research grant, Elbit Medical Imaging Ltd Research support, General Electric Company Consultant, Elbit Medical Imaging Ltd

Chung Yin Kong PhD, Abstract Co-Author: Nothing to Disclose

John Shannon Swan MD, Abstract Co-Author: Nothing to Disclose

Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS) is an FDA-approved fibroid treatment. To be deemed as beneficial as alternatives, cost-utility analysis (CUA) is needed. Utilities provide quality of life outcome measures for comparison of costs and outcomes. Short-term utilities for procedures are also important, as procedure morbidity can influence CUA. The purpose of this study was: 1) to obtain utilities for the disease state of uterine fibroids pre- and post-treatments with abdominal hysterectomy (HYST), MRgFUS and uterine artery embolization (UAE), and 2) to measure short-term utilities for these treatments. A method of obtaining utilities for short-term health states, the Waiting-Tradeoff (WTO), is a variation on the Time-Tradeoff (TTO), based on the fact that people wait longer to avoid a more noxious test experience. Validated in radiology testing, this is the first attempt to use the WTO to assess utilities for treatments, providing short-term “tolls” on quality of life in terms of Quality-Adjusted Life Weeks (QALW).

Utilities for the health state of uterine fibroids pre- and post- treatment were obtained by telephone interview using the TTO and a visual analogue scale (VAS). Short-term utilities for treatments were obtained using the WTO. WTO wait times were quality-adjusted to QALW using fibroid utilities quantified with TTO, VAS, and a VAS transformation to TTO (tVAS) from the literature. WTO wait times were compared using non-parametric tests.

62 HYST, 75 UAE and 61 MRgFUS patients participated. TTO and VAS utilities increased post-treatment. Post-treatment there was a greater diversity in VAS than TTO. Group VAS scores were lower than TTO. For short-term utilities, median WTO wait times were higher for HYST (21.6 weeks) than for UAE (14.14 weeks, p=0.006 vs. HYST) or MRgFUS (13.86 weeks, p=0.001 vs. HYST). QALW obtained were lower when wait time was scaled with TTO, and higher when scaled with tVAS and VAS.

 TTO and VAS utilities showed an expected increase after all treatments. WTO is feasible for evaluating short-term treatments, and showed increased wait times of HYST, due to its increased morbidity, relative to UAE and MRgFUS.

We obtained fibroid-specific utilities, important for accurate cost-utility analysis of less-invasive treatments. Short-term utility assessment shows less invasive treatments to be more acceptable.

Fennessy, F, Tempany-Afdhal, C, Kong, C, Swan, J, Short-term Utility Analysis of Fibroid Treatment Options and Utility Analysis of Fibroid Treatment Outcomes.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6011684.html