Comparison of outcomes and cost-effectiveness of trisacryl gelatin microspheres alone versus combined trisacryl gelatin microspheres and gelatin sponge embolization in uterine fibroid embolization.
BACKGROUND
Uterine fibroid embolization (UFE) is an effective treatment for uterine leiomyomata. Optimizing the choice of embolic agents is imperative to achieve better patient outcomes with maximum resource utilization.


PURPOSE
To evaluate the efficacy and cost-effectiveness of trisacryl gelatin microspheres (TAGM) versus combined TAGM and gelatin sponge (GS) embolization in the treatment of symptomatic uterine leiomyomata.


MATERIAL AND METHODS
Between July 2007 and December 2010, 106 consecutive patients underwent UFE with TAGM. Between January 2011 and December 2016, 123 consecutive patients underwent UFE with a combination of TAGM/GS. The primary outcomes were successful infarction rate (≥90% infarction) of the dominant leiomyoma and percentage reduction in uterine and dominant leiomyoma volume on MRI at six months. Secondary outcomes included adverse event rates, pain scores, and change in clinical symptoms at six months. The embolic agents utilized per procedure were recorded and a cost-effectiveness analysis was performed.


RESULTS
Baseline characteristics of both groups were similar. Successful infarction was achieved in 93.2% of the TAGM group and 94.6% of the TAGM/GS group (P = 0.52). Reduction in uterine volume (TAGM 40.7%, TAGM/GS 44.4%, P = 0.16) and dominant leiomyoma volume (TAGM 47.6%, TAGM/GS 50.1%, P = 0.29) at six months was similar. No significant difference was observed in symptom improvement at six months (P = 0.8). The mean number of TAGM vials utilized and cost per procedure was 6.3 and $1688.40 for TAGM embolization and 3.6 and $979.50 for TAGM/GS embolization, respectively.


CONCLUSION
Primary and secondary outcomes were comparable when performing UFE with TAGM versus combined TAGM/GS. The combined use of TAGM/GS reduced the mean cost of embolic agents by 42%.
['Farrell|Terence P|TP|https://orcid.org/0000-0002-5767-0908', 'Garvey|Chris|C|', 'Adams|Niamh C|NC|', 'Mulholland|Douglas|D|', 'Ryan|J Mark|JM|', 'Guiney|Michael|M|', 'McEniff|Niall|N|']
D000180:Acrylic Resins D000328:Adult D003287:Contrast Media D003362:Cost-Benefit Analysis D005260:Female D005780:Gelatin D006801:Humans D007889:Leiomyoma D008279:Magnetic Resonance Imaging D008536:Meglumine D009942:Organometallic Compounds D010147:Pain Measurement D012189:Retrospective Studies D055357:Uterine Artery Embolization D014594:Uterine Neoplasms
cost-effectiveness embolization Vascular adults interventional uterus