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Cost Comparison of Fibroid Treatment

When we consider the cost of a treatment we must look at the cost to the NHS in the short and longer term, the cost to the patients and their families, who may have to take time off work to look the woman and the costs to employers and society. It is important to people that they recover quickly and get back to normal life as soon as possible. Most women cannot afford to take 3 months off work, especially if they run their own business, have a senior position, are on piece work or have family responsibilities. NICE has not considered the costs to patients, their families and society in the past.

The NHS has a tariff which is an average cost of treatment in England. The table below shows the current tariff and there are considerable savings to be made for the NHS.

In April 2011 a new 'Best Practice Tariff' will be introduced for UFE to encourage hospital trust to offer UFE. It will allow them to make more surplus than hysterectomy. The Department of Health wants to encourage less hysterectomies and more less invasive treatments such as UFE.

Cost Comparisons
Procedure Hysterectomy Myomectomy Embolisation
Payment by Results Tariff '10-'11

£2,614

£2,614 - £1,970

£1,763

Payment by Results Tariff Apr 11 Best Practice Tariff for UFE

£2,675

£2,675

£2,438

The tariff shown is abdominal hysterectomy. Tariffs for myomectomy are for abdominal and laparoscopic.

In the table below we show how much the NHS could save if all the 60% of hysterectomies performed for fiobroids in England each year were converted to UFE. FEmISA does not advocate this as all women should have a choice in treatment, but most do not as they are not told of alternatives to hysterectomy.

 

Potential Saving on In-Patient Costs from Treatments with Embolisation instead of Hysterectomy

 

The 2010/11   tariff for UFE was £1,763 and the hysterectomy tariff is £2,614 a saving of   £851 per procedure. From April’11 a   new Best Practice tariff of £2,483 for UFE was introduced and the new tariff   is £2,675 for hysterectomy. This will   still offer a saving of £202 per treatment.   Here is an analysis for England as a whole on the savings that can be   made if all the 60%* of hysterectomies for fibroids were switched to   UFE.                                       *(In the recent FOI survey carried out by MTG 60% of in-patient   treatments for fibroids were UFE and we have used this as an achieveable   benchmark)

     

Past   Savings Under Old 10-11 PbR Tariff

   

Total   number of Hysterectomies in England

               37,919

 

60% for   fibroids

               22,751

 

In-patient   cost of Hysterectomy

£       59,472,160

 

In-patient   costs for same number of embolisations

£       40,110,718

 
     

Potential   Cost saving by treating with embolisation

£       19,361,441

 

Number   of potential bed days saved

               77,355

 
     

Savings   Under Current '12-13 PbR Tariff

   

Total   number of Hysterectomies in England

               39,000

 

60% for   fibroids

               23,400

 

In-patient   cost of Hysterectomy (MA07B £2,675)

£       62,595,000

 

If 60% of   hysterectomies for fibroids were treated by UFE - costs

£       34,861,320

 

(60% e.g.   Heart of England)(RC41Z BPT UFE £2,483)

   

Potential   Cost saving by treating 60% with embolisation

£       2,836,080

 

Number   of potential bed days saved

             70,200

 
     

Further potential cost savings

  • Reduction in HRT usage from early menopause associated with hysterectomy
  • Reduction in short and longer term readmissions and morbidity

It is also important to look at some of the costs to patients and their families and employers.

Reduction in cost of patients and their families

  • Less need for care at home from family member
  • Return to work/normal life 1-2 weeks with embolisation c.f. Hysterectomy 3 months
  • Early HRT use much less likely - prescription charges per hormone so at least double normal charge
  • Reduction in cost to the economy, employers, society
  • Return to work/normal life 1-2 weeks with embolisation c.f. Hysterectomy 3 months

 

Reduction in Cost to the Economy, Employers and Society

Return to work/normal life 1-2   weeks with embolisation c.f. Hysterectomy 3 months

2 weeks off work versus 3   months - working days saved

           1,251,327

Average weekly earnings Jun '12   [Office for National Statistics]

£               468.00

Potential   economic saving from earlier return to work from UFE

£ 117,124,207

 

 Estimated Full Annual Costs of Fibroids in USA

A clinical study from USA on the total costs   of fibroids to the healthcare system and to the economy as a whole has been   publishedrecently. [The estimated annual cost of uterine leiomyomata in the   United States. Am J Obstet Cardozo ER,   Clark AD, Banks NK, Henne MB, Stegmann BJ, Segars JH - Am J Obstet Gynecol.   2012 Mar;206(3):211.e1-9. Epub 2011 Dec 11]

Estimated   annual direct costs (surgery, hospital admissions,

$4.1-9.4 billion

 

outpatient visits, and   medications)

   

Estimated   lost work-hour costs - annually

$1.55-17.2 billion

 

Obstetric   outcomes that were attributed to fibroids

$238m -   $7.76 bn

 
     

Total   costs attributed to fibroids annually

$5.9-34.4   billion