A Cost-Utility Analysis of Microwave Endometrial Ablation versus Thermal Balloon Endometrial Ablation

Objective: To evaluate the cost-effectiveness of microwave endometrial ablation (MEA) and thermal balloon endometrial ablation (TBALL) for heavy menstrual bleeding.

Methods: A cost-utility analysis performed alongside a pragmatic RCT in a single hospital within Scotland on women undergoing MEA and TBALL. Resource use data collected from all 314 trial participants were combined with study specific and published unit cost data to estimate a cost per patient. Quality-adjusted life-years (QALYs) were based on EQ-5D responses at baseline, 2 weeks, 6 and 12 months. The incremental cost per QALY of TBALL versus MEA was calculated and bootstrapping was performed to determine the likelihood that a treatment would be cost-effective at different threshold values for society's willingness to pay for a QALY.

Results: The mean cost of TBALL (10 years equipment life, 100 uses annually) of reusable equipment was 181 pound (95% confidence interval [CI] 70-434) pound greater than MEA. There were no statistically significant differences between the total nonhealth costs and health benefits of the two arms. On average, MEA provided more QALYs after adjusting for baseline EQ-5D score (0.017; 95% CI 0.017-0.051). In terms of mean incremental cost per QALY, MEA was, on average, dominant (less costly and at least as effective) and there was over a 90% chance that MEA would be considered cost-effective at a 20,000 pound threshold of a cost per QALY.

Conclusions: MEA is likely to be more cost-effective than TBALL at 1 year. Further longer-term follow-up is, however, needed.