Successful term pregnancy following MR-guided focused ultrasound treatment of uterine leiomyoma

Systematic review of reproductive outcomes after High Intensity Focused Ultrasound treatment of uterine fibroids

PURPOSE

Myomectomy is currently the gold standard for the treatment of uterine fibroids in women who desire pregnancy. However, this surgical fibroid removal has a long convalescence. Promising alternatives may be non-invasive High Intensity Focused Ultrasound (HIFU) under either MRI (MR-HIFU) or ultrasound guidance (USgHIFU). In this systematic review, an overview is provided of reproductive outcomes after these two relatively new ablation techniques.

METHOD

A systematic literature search was performed to identify studies reporting reproductive outcomes after HIFU treatment of fibroids. Only peer reviewed, full papers were included. Outcomes included pregnancy-, live-birth- miscarriage and caesarian section rate, time to conceive, reported complications, and possible prognostic factors.

RESULTS

In total 21 studies were included. Fourteen studies reported 124 pregnancies after MR-HIFU. Two placenta previas and no uterus ruptures were reported. Pregnancy rates were only retrospectively collected and ranged between 7% and 36%. Miscarriage rate in the oldest and largest prospective registry was 39%. After USgHIFU 366 pregnancies were reported with one fetal intrauterine death, six placenta previas and no uterus ruptures. The only prospective study reported a pregnancy rate of 47% and a miscarriage rate of 11%. Possible prognostic factors like age were not available in most studies.

CONCLUSIONS

Based on the heterogeneous data currently available, reproductive outcomes after HIFU appear non-inferior to outcomes after the current standard of care. However, a (randomized) controlled trial comparing reproductive outcomes after HIFU and standard care is necessary to provide sufficient evidence on the preferred fibroid treatment for women with a pregnancy wish.

The INTEGRITY Trial: Preservation of Uterine-Wall Integrity 12 Months After Transcervical Fibroid Ablation with the Sonata System

Objective: The aim of this research was to evaluate uterine-wall integrity 12 months after transcervical fibroid ablation (TFA) of uterine fibroids with the Sonata^® system (Gynesonics Inc., Redwood City, CA).

Materials and Methods: INTEGRITY is a secondary analysis of the FAST-EU clinical trial, a prospective, longitudinal, multicenter single-armed trial involving women with heavy menstrual bleeding secondary to fibroids who were treated at 7 academic and community hospitals in the United Kingdom, the Netherlands, and Mexico with transcervical, intrauterine, ultrasound-guided radiofrequency ablation (the Sonata system). TFA was performed on up to 5 fibroids per subject ranging from 1–5 cm in diameter as determined by magnetic resonance imaging (MRI). All measurements and comparisons, including uterine-wall thicknesses were derived from baseline and 12-month MRI scans by an independent core MRI center. Scans were analyzed to assess preservation of uterine-wall integrity and reviewed for uterine-wall anomalies after TFA with the Sonata system.

Results: Twenty-nine patients had baseline and 12-month MRI with contrast enhancement. Minimum uterine-wall thicknesses in all visible slices were >2.5 mm in diameter. No areas on MRI indicated any loss of uterine-wall integrity, compared with baseline imaging; comparison of baseline and postablation uterine-wall thicknesses revealed no significant changes.

Conclusion: Transcervical fibroid ablation with the Sonata system was associated with preservation of uterine-wall integrity in this patient cohort.

Alternatives to excisional therapy: a clinical review of our current options to conservatively manage symptomatic leiomyomas

PURPOSE OF REVIEW

This article provides a clinical review of the alternatives to traditional excisional surgical therapies for uterine leiomyomas, such as myomectomy or hysterectomy.

RECENT FINDINGS

In this review, currently available hormonal medications will be briefly discussed. Then, nonhormonal medical therapy will be addressed with respect to mechanism of action, safety, and efficacy. Finally, the risk-benefit profile of nonexcisional procedures for management of leiomyomas will be addressed.

SUMMARY

This provides an update on the information available for more conservative options for symptomatic leiomyoma management.

Management of Uterine Fibroids: A Focus on Uterine-sparing Interventional Techniques

Uterine fibroids occur in approximately 50% of women over the age of 40 years, and an estimated 50% of those are symptomatic. Menorrhagia is the most common symptom and the primary indication for treatment, although bulk symptoms often occur and can be treated. Pharmacotherapy is typically inadequate unless it can be expected to successfully bridge to menopause or allow for a less-invasive intervention. However, hormonal therapies have risks. Hysterectomy is still the most commonly performed procedure for symptomatic fibroids and has the lowest rate of reintervention (compared with myomectomy or uterine artery embolization [UAE]), but rates of more serious complications are higher and patient satisfaction and ability to return to normal activities may also be less favorable. Myomectomy is not necessarily less morbid than hysterectomy and may have a greater failure rate than UAE. Techniques and devices vary with little standardization, and operator experience is crucial to success. The largest studies of UAE show very low rates of serious complications and rapid recovery. UAE significantly improves symptoms related to uterine fibroids in 85%-90% of patients. Herein, this article will discuss the nature of fibroids and their diagnosis, pharmacotherapy, surgical treatment, and nonsurgical interventional treatment, including UAE and magnetic resonance-guided focused ultrasound. (©) RSNA, 2016.

Magnetic Resonance Imaging-Guided Focused Ultrasound Surgery for the Treatment of Symptomatic Uterine Fibroids

Uterine fibroids, the most common benign tumor in women of childbearing age, may cause symptoms including pelvic pain, menorrhagia, dysmenorrhea, pressure, urinary symptoms, and infertility. Various approaches are available to treat symptomatic uterine fibroids. Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) represents a recently introduced noninvasive safe and effective technique that can be performed without general anesthesia, in an outpatient setting. We review the principles of MRgFUS, describing patient selection criteria for the treatments performed at our center and we present a series of five selected patients with symptomatic uterine fibroids treated with this not yet widely known technique, showing its efficacy in symptom improvement and fibroid volume reduction.

A New Paradigm for Uterine Fibroid Treatment: Transcervical, Intrauterine Sonography-Guided Radiofrequency Ablation of Uterine Fibroids with the Sonata System

Purpose of Review

This article provides the current evidence related to transcervical radiofrequency ablation of uterine fibroids under integrated intrauterine sonography guidance (the Sonata System).

Recent Findings

Published data on the treatment of fibroids with the Sonata System has demonstrated significant median reductions in total (73.3%) and perfused (73.3%) uterine fibroid volume, menstrual bleeding (72.3%), symptom severity (62.5%), and improvements in health-related quality of life (127%) at 12 months post-ablation. A clinical trial under an FDA Investigational Device Exemption is in progress.

Summary

The Sonata System is a promising treatment modality for uterine fibroids. As an incisionless, minimally invasive treatment that does not require general anesthesia or hospitalization, it has the potential for redefining the current paradigm for management of symptomatic fibroids.

Potential of minimally invasive procedures in the treatment of uterine fibroids: a focus on magnetic resonance-guided focused ultrasound therapy

Minimally invasive treatment options are an important part of the uterine fibroid-treatment arsenal, especially among younger patients and in those who plan future pregnancies. This article provides an overview of the currently available minimally invasive therapy options, with a special emphasis on a completely noninvasive option: magnetic resonance-guided focused ultrasound (MRgFUS). In this review, we describe the background of MRgFUS, the patient-selection criteria for MRgFUS, and how the procedure is performed. We summarize the published clinical trial results, and review the literature on pregnancy post-MRgFUS and on the cost-effectiveness of MRgFUS.

Update on Clinical Magnetic Resonance-Guided Focused Ultrasound Applications

In this review, several clinical applications of magnetic resonance (MR)-guided focused ultrasound (FUS) are updated. MR-guided FUS is used clinically for thermal ablation of uterine fibroids and bone metastases. Thousands of patients have successfully been treated. Transcranial MR-guided FUS has received CE certification for ablation of deep, central locations in the brain. Thermal ablation of specific parts of the thalamus can result in relief of the symptoms in a number of neurological disorders. Several approaches have been proposed for ablation of prostate and breast cancer and clinical trials should show the potential of MR-guided FUS for these and other applications.

Volumetric MR-guided high-intensity focused ultrasound versus uterine artery embolisation for treatment of symptomatic uterine fibroids: comparison of symptom improvement and reintervention rates

PURPOSE

To compare the effectiveness of magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) with that of uterine artery embolisation (UAE) for treatment of uterine fibroids.

METHODS

Between January 2010 and January 2013, 51 women with symptomatic uterine fibroids underwent MR-HIFU. Follow-up and MR imaging were compared to 68 women treated with UAE, who fulfilled eligibility criteria for MR-HIFU - e.g., size (≤ 12 cm) and number (≤ 5) of fibroids. We compared median symptom severity (tSSS), total health-realted quality of life (HRQoL) scores, and reintervention rates. The adjusted effect on symptom relief and HRQoL improvement was calculated using multivariable linear regression. Cox regression was applied to calculate the adjusted risk of reintervention between both treatments.

RESULTS

Median tSSS improved significantly from baseline to three-month follow-up (P < 0.001) for both MR-HIFU (53.1 (IQR [40.6-68.8]) to 34.4 (IQR [21.9-46.9]) and UAE (65.3 (IQR [56.3-74.2]) to 21.9 (IQR [9.4-34.4]). In addition, significantly better HRQoL scores were observed after three months (P < 0.001). However, in multivariate analysis, UAE had a stronger effect on symptom relief and HRQoL improvement than MR-HIFU (P < 0.001). Patients treated with MR-HIFU had a 7.1 (95 % CI [2.00-25.3]; P = 0.002) times higher risk of reintervention within 12 months (18/51 vs. 3/68).

CONCLUSION

Both MR-HIFU and UAE result in significant symptom relief related to uterine fibroids. However, MR-HIFU is associated with a higher risk of reintervention.

KEY POINTS

• This study compared outcomes between volumetric MR-HIFU and UAE for uterine fibroids. • Both MR-HIFU and UAE result in significant symptom relief and quality of life improvement. • UAE had a stronger positive effect on the clinical outcomes. • Reintervention rate after MR-HIFU ablation was significantly higher than after UAE.

Reproductive impact of MRI-guided focused ultrasound surgery for fibroids: a systematic review of the evidence

PURPOSE OF REVIEW

Magnetic-resonance-guided focused ultrasound surgery (MRgFUS) is a minimally invasive technique for the treatment of uterine fibroids. The purpose of this review is to highlight the impact of MRgFUS on fertility and reproductive outcomes.

RECENT FINDINGS

The role of MRgFUS in the treatment of fibroids has been evolving since its introduction in 2004. Several new devices and techniques including location-specific treatment, volumetric therapy, and vessel-targeted therapy have been introduced over the last few years. Several case series report uncomplicated pregnancy following MRgFUS; however, results of the ongoing studies will further elucidate the utility of MRgFUS in patients planning future fertility. A systematic review of the literature was completed and studies that reported quality of life at baseline and after 6 months were included in a meta-analysis.

SUMMARY

MRgFUS represents a minimally invasive treatment for uterine fibroids that is able to improve the quality of life and fibroid size with durability. It is possible that MRgFUS could be the treatment of choice for patients desiring future fertility; however, further investigation is needed.

High-Intensity Focused Ultrasound Ablation of Uterine Fibroids - Potential Impact on Fertility and Pregnancy Outcome

Laparoscopic myomectomy is regarded as the gold standard for women with symptomatic fibroids who wish to become pregnant. High-intensity focused ultrasound (HIFU or MRgFUS) ablation of uterine fibroids is also being discussed as a non-surgical, minimally invasive, therapeutic option. This review examines the available data on the impact of HIFU/MRgFUS on fertility and pregnancy, focusing particularly on potential direct side-effects of this type of intervention on ovaries, fallopian tubes and uterus and potential late effects on pregnancy and birth, based on the current literature. All pregnancies after HIFU/MRgFUS published to date (around 100 cases) were evaluated. The published case series suggest that HIFU/MRgFUS ablation has no impact on the rate of miscarriages or other obstetrical outcome parameters. Because no prospective studies exist which permit firm conclusions to be drawn on the impact of HIFU/MRgFUS on fertility and pregnancy outcome in women with symptomatic fibroids, this approach is currently only recommended for women with suspected fertility problems due to uterine fibroids who either decline surgery or who have an unacceptably high surgical risk.

Clinical and Technical Aspects of MR-Guided High Intensity Focused Ultrasound for Treatment of Symptomatic Uterine Fibroids

Although many women undergo hysterectomy for treatment of uterine fibroids, there are more options than ever before for fibroid treatment. A combination of objective criteria, including clinical parameters, anatomic factors, fibroid characteristics, and patient desires influence the choice of optimal therapeutic modality for a woman with symptomatic uterine fibroids. Magnetic resonance imaging-guided high intensity focused ultrasound (MR-HIFU) is the only noninvasive treatment option for women with symptomatic uterine fibroids unresponsive to medical treatment. The procedure has been shown to be safe and effective. MR-HIFU couples the three-dimensional multiplanar anatomic imaging and thermal monitoring capability of MR imaging with the therapeutic thermal-based coagulative necrosis mechanism of HIFU to safely and effectively ablate limited volume classical fibroids. In the author's experience, a multidisciplinary fibroid clinic facilitates a unified approach between gynecologists, radiologists, and others to individualize the most appropriate fibroid treatment options for each woman. This article describes the MR-HIFU technique and outcomes, as well as patient selection and treatment assessment.

Noninvasive treatment of focal adenomyosis with MR-guided focused ultrasound in two patients

Adenomyosis is a common benign gynecological disorder presenting with dysmenorrhea, menorrhagia, and pressure symptoms. Magnetic resonance imaging–guided focused ultrasound surgery (MRgFUS) utilizes precisely focused USG waves to generate and maintain high temperatures within the targeted tissue to achieve protein denaturation and coagulative necrosis. The heat generated is monitored using MRI images acquired in real-time in three planes. We present two cases of focal adenomyosis treated with MRgFUS showing good symptomatic relief at 3 and 6 months follow-up.

High-intensity focused ultrasound: principles, therapy guidance, simulations and applications

In the past two decades, high-intensity focused ultrasound (HIFU) in combination with diagnostic ultrasound (USgFUS) or magnetic resonance imaging (MRgFUS) opened new ways of therapeutic access to a multitude of pathologic conditions. The therapeutic potential of HIFU lies in the fact that it enables the localized deposition of high-energy doses deep within the human body without harming the surrounding tissue. The addition of diagnostic ultrasound or in particular MRI with HIFU allows for planning, control and direct monitoring of the treatment process. The clinical and preclinical applications of HIFU range from the thermal treatment of benign and malign lesions, targeted drug delivery, to the treatment of thrombi (sonothrombolysis). Especially the therapy of prostate cancer under US-guidance and the ablation of benign uterine fibroids under MRI monitoring are now therapy options available to a larger number of patients. The main challenges for an abdominal application of HIFU are posed by partial or full occlusion of the target site by bones or air filled structures (e.g. colon), as well as organ motion. In non-trivial cases, the implementation of computer based modeling, simulation and optimization is desirable. This article describes the principles of HIFU, ultrasound and MRI therapy guidance, therapy planning and simulation, and gives an overview of the current and potential future applications.

MR-guided focused ultrasound for the treatment of uterine fibroids

Magnetic resonance imaging-guided focused ultrasound (MRgFUS) ablation of uterine fibroids provides a minimally invasive outpatient technique for targeting and treating symptomatic uterine fibroids. Magnetic resonance imaging provides a guidance platform that has high temporal and spatial resolution for guiding, as well as thermal monitoring of the procedure. The high-intensity focused ultrasound provides a mechanism for delivering large amounts of energy directly into the fibroid without causing detrimental effects to the nontarget tissues. Early and intermediate follow-up of patients treated with MRgFUS provided promising results on the efficacy of the technique for providing symptom relief to patients. As more long-term follow-up data are published, the efficacy of this technique can be compared to more invasive surgical and minimally invasive catheter treatments.

MRgFUS treatment of uterine fibroid in a nulliparous woman with acute retention of urine

Uterine fibroids are the most common tumors of the female reproductive tract. Although most fibroids are asymptomatic, about 25% are associated with symptoms that can have a significant impact on patient's quality of life, including prolonged or excessive menstrual bleeding, pelvic pain or bulkiness, dyspareunia, increased urinary frequency, and infertility. Various treatment options available for symptomatic uterine fibroids include hysterectomy, myomectomy (abdominal or laparoscopic), uterine artery embolization, MR-guided Focused Ultrasound (MRgFUS), and hormonal therapy, which also is sometimes used as adjuvant to other therapies. MRgFUS is a non-invasive treatment approach for symptomatic uterine fibroids. The following case report demonstrates successful treatment of a fibroid that is hyper-intense on T2WIs by MRgFUS with immediate alleviation of pressure symptoms on the urinary bladder.

Radiofrequency ablation for treatment of symptomatic uterine fibroids

The use of thermal energy-based systems to treat uterine fibroids has resulted in a plethora of devices that are less invasive and potentially as effective in reducing symptoms as traditional options such as myomectomy. Most thermal ablation devices involve hyperthermia (heating of tissue), which entails the conversion of an external electromagnetic or ultrasound waves into intracellular mechanical energy, generating heat. What has emerged from two decades of peer-reviewed research is the concept that hyperthermic fibroid ablation, regardless of the thermal energy source, can create large areas of necrosis within fibroids resulting in reductions in fibroid volume, associated symptoms and the need for reintervention. When a greater percentage of a fibroid's volume is ablated, symptomatic relief is more pronounced, quality of life increases, and it is more likely that such improvements will be durable. We review radiofrequency ablation (RFA), one modality of hyperthermic fibroid ablation.

Magnetic resonance-guided focused ultrasound for uterine fibroids

Uterine fibroids are an important problem for women of reproductive age. Although hysterectomy has been the traditional treatment for fibroids, many women are interested in a less invasive therapy. Magnetic resonance-guided focused ultrasound (MRgFUS) is a new technique for treating a variety of solid tumors. It has been tested and approved by the U.S. Food & Drug Administration (FDA) for the treatment of uterine fibroids. The procedure is completely noninvasive. It is performed as an outpatient procedure and the patient can resume her normal activities the day following the procedure. Techniques of treatment of uterine fibroids are still being refined, but significant progress has been made in understanding some of the challenges for this new technology. Some fibroids are more responsive to the focused ultrasound; some fibroids are more resistant. Not all women are candidates for this procedure. Absolute contraindications include bowel that is in the path of the ultrasound beam, or surgical scars in the beam pathway. The procedure of MRgFUS is feasible, safe and becoming increasingly popular. Questions still remain particularly the use of this technique for patients desiring fertility, and what will be the long-term results.

Focused ultrasound surgery in oncology: overview and principles

Focused ultrasound surgery (FUS) is a noninvasive image-guided therapy and an alternative to surgical interventions. It presents an opportunity to revolutionize cancer therapy and to affect or change drug delivery of therapeutic agents in new focally targeted ways. In this article the background, principles, technical devices, and clinical cancer applications of image-guided FUS are reviewed.

Eligibility and accessibility of magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment of uterine leiomyomas

OBJECTIVE

To evaluate patient eligibility and accessibility of magnetic resonance-guided focused ultrasound (MRgFUS) for women with symptomatic uterine leiomyomas who desire conservative therapy.

DESIGN

Retrospective analysis of 169 patients referred for minimally invasive treatment of leiomyomas between November 2007 and February 2009. Clinical eligibility for MRgFUS was determined by Food and Drug Administration-based treatment guidelines. All patients underwent pretreatment pelvic imaging to determine candidacy for the procedure.

PATIENT(S)

Premenopausal women with symptomatic uterine leiomyomas.

SETTING

Academic medical center.

MAIN OUTCOME MEASURE(S)

Eligibility for MRgFUS based on clinical and anatomic patient criteria.

RESULT(S)

Forty-seven percent of patients (80/169) were determined clinically eligible for the procedure. Of these, 16% of patients (27/169) were found to be eligible for MRgFUS based on imaging results. Overall, the main reasons for ineligibility were very large leiomyomas (8%; 14/169), cost (12%; 21/169), and desired fertility (14%; 23/169). An additional 48% of patients declined MRgFUS for unstated reasons, often after obtaining financial and insurance coverage information.

CONCLUSION(S)

Currently, many women with leiomyomas are unable to obtain MRgFUS treatment for multiple reasons, including uterine size, desire for fertility, and, most commonly, financial limitations. With increasing clinical experience, further research, and broadened insurance coverage, it may be possible to increase accessibility and expand eligibility criteria for this minimally invasive therapy.

Pregnancy and natural delivery following magnetic resonance imaging-guided focused ultrasound surgery of uterine myomas

This report discusses a pregnancy case following a series of two consecutive magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS) procedures for the treatment of two different myomas in an individual patient. Both procedures were completed without adverse events, and the patient conceived naturally four months after treatment. At 39 weeks, she gave birth to a healthy baby girl, via a vaginal delivery. There were no complications in the pregnancy or during labor.

Uncomplicated term vaginal delivery following magnetic resonance-guided focused ultrasound surgery for uterine fibroids

A 35 year-old para 1+0 underwent MRgFUS per study protocol for multiple uterine fibroids, the largest of which measured 5 cm. She conceived 10 months following the procedure. The patient was induced at 41+6 weeks and underwent a normal vaginal delivery.

Image-guided thermal therapy of uterine fibroids

Thermal ablation is an established treatment for tumors. The merging of newly developed imaging techniques has allowed precise targeting and real-time thermal mapping. This article provides an overview of the image-guided thermal ablation techniques in the treatment of uterine fibroids. Background on uterine fibroids, including epidemiology, histology, symptoms, imaging findings, and current treatment options, is first outlined. After describing the principle of magnetic resonance thermal imaging, we introduce the applications of image-guided thermal therapies, including laser ablation, radiofrequency ablation, cryotherapy, and in particular, magnetic resonance-guided focused ultrasound surgery, and how they apply to uterine fibroid treatment.

Cost-effectiveness of magnetic resonance guided focused ultrasound for the treatment of uterine fibroids

OBJECTIVES

The aim of this study is to evaluate the cost-effectiveness of Magnetic Resonance Guided Focused Ultrasound (MRgFUS) compared with alternative treatments for uterine fibroids in the United States.

METHODS

We used techniques of decision analysis and data from secondary sources to develop and estimate an economic model of the management of uterine fibroids among premenopausal women. Patients in the model receive treatment with MRgFUS, uterine artery embolization (UAE), abdominal myomectomy, hysterectomy, or pharmacotherapy. The model predicts total costs (including subsequent procedures) and quality-adjusted life-years (QALYs) for each treatment strategy over a lifetime horizon, discounted at 3 percent, from a societal perspective. Data on treatment efficacy and safety were obtained from published and unpublished studies. Costs (2005 US$) were obtained from an analysis of a large administrative database and other secondary sources. Lost productivity costs were included in the base-case analysis, but excluded in a sensitivity analysis.

RESULTS

UAE was associated with the most QALYs (17.39), followed by MRgFUS (17.36), myomectomy (17.31), hysterectomy (17.18), and pharmacotherapy (16.70). Pharmacotherapy was the least costly strategy ($9,200 per patient), followed by hysterectomy ($19,800), MRgFUS ($27,300), UAE ($28,900), and myomectomy ($35,100). Incremental cost-effectiveness ratios (cost per QALY gained) were $21,800 for hysterectomy, $41,400 for MRgFUS, and $54,200 for UAE; myomectomy was more costly and less effective than both MRgFUS and UAE. Results were sensitive to MRgFUS recurrence rates, MRgFUS procedure costs, and assumptions about quality of life following hysterectomy.

CONCLUSIONS

Our findings suggest that MRgFUS is in the range of currently accepted criteria for cost-effectiveness, along with hysterectomy and UAE.

Cost-effectiveness of magnetic resonance-guided focused ultrasound surgery for treatment of uterine fibroids

Objective

To estimate the cost-effectiveness of a treatment strategy for symptomatic uterine fibroids, which starts with Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) as compared with current practice comprising uterine artery embolisation, myomectomy and hysterectomy.

Design

Cost-utility analysis based on a Markov model.

Setting

National Health Service (NHS) Trusts in England and Wales.

Population

Women for whom surgical treatment for uterine fibroids is being considered.

Methods

The parameters of the Markov model of the treatment of uterine fibroids are drawn from a series of clinical studies of MRgFUS, and from the clinical effectiveness literature. Health-related quality of life is measured using the 6D. Costs are estimated from the perspective of the NHS. The impact of uncertainty is examined using deterministic and probabilistic sensitivity analysis.

Main outcome measures

Incremental cost-effectiveness measured by cost per quality-adjusted life-year (QALY) gained.

Results

The base-case results imply a cost saving and a small QALY gain per woman as a result of an MRgFUS treatment strategy. The cost per QALY gained is sensitive to cost of MRgFUS relative to other treatments, the age of the woman and the nonperfused volume relative to the total fibroids volume.

Conclusions

A treatment strategy for symptomatic uterine fibroids starting with MRgFUS is likely to be cost-effective.

Please cite this paper as: Zowall H, Cairns J, Brewer C, Lamping D, Gedroyc W, Regan L. Cost-effectiveness of magnetic resonance-guided focused ultrasound surgery for treatment of uterine fibroids. BJOG 2008;115:653–662.