The effectiveness and cost-effectiveness of microwave and thermal balloon endometrial ablation for heavy menstrual bleeding: a systematic review and economic modelling.

摘要: Objectives To estimate the clinical effectiveness and cost-effectiveness of microwave endometrial ablation (MEA) thermal balloon (TBEA) for heavy menstrual bleeding (HMB), compared with existing (first-generation) (EA) techniques transcervical resection (TCRE) rollerball (RB) ablation, hysterectomy. Data sources Electronic databases, bibliographies articles, also experts in field relevant industry bodies were asked to provide information. Review methods A detailed search strategy was carried out identify systematic reviews controlled trials MEA TBEA versus first-generation EA. In addition electronic database searching, reference lists hand-searched information sought from manufacturers EA devices by field. deterministic Markov model developed assess cost-effectiveness. taken a range sources. Results The review hysterectomy found that offered an alternative HMB, fewer complications shorter recovery period. Satisfaction high both TBEA. Costs lower although difference narrows over time. Second-generation are treatment known offer Although no second-generation have been undertaken, it seems reasonable assume surgical treatment. Using cost-effectiveness, costs very slightly higher when TBEA, differences quality-adjusted life-years (QALYs) negligible. For endometrium RB accrued more QALYs. Compared hysterectomy, less accrues TCRE moderately Conclusions Overall, there few significant between outcomes first- including bleeding, satisfaction QoL measures repeat surgery rates. had significantly operating theatre times appear be serious perioperative adverse effects postoperative similar. quicker perform result hospitalisation faster return work. Hysterectomy results is expensive, need retreatment leads this decrease initially higher, but after 2 years. economic suggests cost-effective than HMB. Both costly latter Further research suggested make direct comparisons techniques, carry longer term follow-up all RCTs, develop sophisticated modelling studies. recommended into HMB establish health-state utility values, its treatment, convalescence, symptoms patient satisfaction.