MEA: The Cost Benefits
Microsulis commissioned an independent economic evaluation of MEA compared with other first and second-generation EA treatments and with hysterectomy. 1
The cost effectiveness of MEA is estimated using a decision model, on the basis of available data in the literature. Benefits are expressed in terms of quality-adjusted life-years, QALYs 2 (which are utility weighted survival estimates), and included costs of resources incurred by procedures and the costs associated with the management of complications. 3
Results
MEA is found to be a cost saving treatment in comparison to all other procedures. The total discounted five-year cost including the initial procedure, further procedures and complications from procedures, is estimated to be approximately £1200. This is a cost saving of 14%-55% over other treatments.
Women undergoing MEA are expected to accrue more QALYs than if they underwent an alternative ablation procedure. (QALYs are only greater with hysterectomy but an additional cost of £4,594 per extra QALY would be incurred.)
Where MEA is introduced as an alternative to hysterectomy, it offers potentially significant savings to the NHS. Although a proportion of patients may subsequently need further treatment, 82 percent of patients diverted from hysterectomy to MEA will not subsequently have a hysterectomy. The cost effectiveness study shows that the savings per patient diverted from an initial hysterectomy are £1,177, i.e. £1.18 million per thousand patients transferred.
Further RCT4 results have shown that MEA can be undertaken either within an operating theatre environment or as an office procedure under local anaesthetic. MEA is also effective where the patient is scheduled in the early proliferative phase of the menstrual cycle - negating the need for endometrial thinning agents (ETAs).
The cost to the NHS reduces by up to a further 49% when MEA is introduced as an office procedure, under local anaesthetic, without the use of ETAs.
1. The results of that evaluation have been included in the company's submission to the National Institute for Clinical Evidence (NICE) on their assessment of Endometrial Ablation for the Treatment of Menorrhagia as requested by the UK Department of Health and the Welsh Assembly Government.
2. A quality-adjusted life year (QALY) takes in to account both quantity and the quality of life generated by healthcare interventions. It is the arithmetic product of life expectancy and a measure of the quality of the remaining life years.
3. Costs were calculated from the perspective of the UK National Health Service (NHS) and included costs of resources incurred by procedures and management of complications (e.g. Staff and theatre time, inpatient stay, and ablation equipment) and the costs of additional surgical procedures resulting from recurrence of symptoms were calculated. 4 Wallage S, Cooper KG, Graham W, Parkin DE. "A prospective randomised controlled trial comparing Microwave Endometrial Ablation under local and general anaesthetic, acceptability and clinical outcome." BJOG 2003; 110, 799-807.
