The CHOICES Study: Facility Level Comparative Cost, Resource Utilization, and Outcomes Analysis of Myomectomy Compared to Transcervical Fibroid Ablation
Received 19 March 2020
Accepted for publication 28 May 2020
Published 12 June 2020 Volume 2020:12 Pages 299—306
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Professor Samer Hamidi
Elizabeth A Brooks,1 Allison M Singer,2 Dipak R Delvadia,3 David Forstein,4,5 Teresa J Beaudoin,6 Robert L Bauserman,1 Matt W Yuen,1 Carter A Little,1 April Zambelli-Weiner1
1TTi Health Research & Economics, Westminster, MD, USA; 2Benaroya Research Institute at Virginia Mason Medical Center, Seattle, WA, USA; 3Drexel University College of Medicine, Philadelphia, PA, USA; 4Greenville Health System, Greenville, SC, USA; 5Touro College of Osteopathic Medicine, New York, NY, USA; 6Mercy Clinical Minimally Invasive Gynecology, St. Louis, MO, USA
Correspondence: Elizabeth A Brooks
TTi Health Research & Economics, 1231 Tech Court, Suite 201, Westminster, MD 21157, USA
Tel/ Fax +1 800-580-2990
Purpose: The CHOICES study compared short-term resource utilization, facility costs, and perioperative patient outcomes between transcervical fibroid ablation (TFA) with the Sonata® system and myomectomy through a case-matched comparative trial design. This is the first facility-level comparative study conducted for TFA.
Patients and Methods: The study enrolled 88 patients from 4 centers equally divided among the two cohorts. The TFA arm consisted of 44 women who had enrolled in the SONATA Pivotal IDE trial, whereas the myomectomy arm included 44 patients who were identified through retrospective case-matching to the enrolled SONATA patients at the same 4 centers.
Results: TFA had a significantly lower mean operating room duration (90 minutes) and length of stay (5.2 hours) than myomectomy (143 minutes and 45.8 hours, respectively). The average total mean facility costs for TFA procedure ($7,563) were significantly lower than those associated with myomectomy ($11,425; p=0.002). TFA mean facility costs were also compared with other stratifications of myomectomy (inpatient or outpatient and surgical route). TFA facility costs were significantly lower than that associated with inpatient, abdominal, or laparoscopic myomectomy (all p< 0.001).
Conclusion: TFA using the Sonata system has a significantly shorter operating room time and length of stay than myomectomy for the treatment of symptomatic uterine fibroids. All procedure, anesthesia, laboratory, pathology, and pharmacy costs were significantly higher for myomectomy as compared to TFA. TFA was also associated with significantly lower facility procedure-related costs compared to myomectomy, including inpatient, abdominal, or laparoscopic myomectomy.
Keywords: uterine fibroids, Sonata, transcervical ablation, uterine preserving, cost, radiofrequency ablation
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