Utility values for pre-menopausal women suffering from symptomatic uterine fibroids

Abstract

Background: Uterine fibroids (UF) represent the most common benign uterine tumor in women of reproductive age. Symptoms including heavy, prolonged menstrual bleeding, pelvic pain/pressure, and/or urinary frequency have a substantial impact on women's quality of life and utility values for UF have not been published. Methods: Health state descriptions associated with UF symptoms and treatment side effects were developed based on patient focus groups; validated using expert clinical input; and pilot tested for understandability. Using a web-based questionnaire, 909 community-dwelling, Canadian women were surveyed to assess their perceived value associated with these states. Results: Utility for uncontrolled bleeding was 0.55 (95% CI: 0.54, 0.57) and the decrement associated with hot flashes was 0.06 (95% CI: −0.07, −0.04). Utility improvement associated with bleeding control was 0.18 (95% CI: 0.17, 0.19) and with smaller fibroid size was 0.03 (95% CI: 0.02, 0.04). Conclusion: These values illustrate the high utility associated with control of excessive menstrual bleeding.

Keywords:

• pre-menopausal
• quality of life
• symptomatic
• uterine fibroids
• utility

Financial & competing interests disclosure

The authors would like to acknowledge Actavis Specialty Pharmaceuticals Co for their financial support of this project. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Uterine fibroids (UFs) are the most common benign tumor of the female reproductive tract with self-reported prevalence of symptomatic UF being 5.5% of the female population in Canada and ranging internationally between 4.5 and 9.8%.

• For women with moderate-to-severe UF considering surgical intervention, assessment of the value of current and future therapies to control bleeding and address symptoms is needed for economic evaluations.

• Our study estimated utility for health states associated with uncontrolled bleeding and change in utility associated with control of bleeding, fibroid size not causing pressure-related symptoms, treatment administration route and presence of hot flashes.

• Health state descriptions associated with UF symptoms and treatment side effects were developed based on patient focus groups, validated using expert clinical input and pilot-tested for understandability.

• Nine hundred and nine community-dwelling Canadian women were surveyed using a web-based questionnaire to assess their perceived value associated with these states by rating each using the EuroQoL-5D-5 level version.

• EuroQoL-5D tariff scoring was applied to obtain utility values for each health state, and changes in utility were calculated by comparison of health states.

• Utility for uncontrolled bleeding was 0.55 (95% CI: 0.54, 0.57).

• Utility improvement associated with bleeding control was 0.18 (95% CI: 0.17, 0.19).

• These results illustrate the high utility associated with control of excessive menstrual bleeding due to UFs.