Keywords
Uterine fibroids
Cost-effectiveness analysis
Health policy
Cost analysis
Systematic review
Abstract
Background. Myomectomy, a fertility-preserving surgical procedure for uterine fibroids the most common benign gynaecological tumours is widely recommended for women desiring future fertility. However, available economic data on myomectomy are limited, methodologically inconsistent, and dispersed across different healthcare systems. This systematic review aimed to evaluate the cost-effectiveness of myomectomy for symptomatic uterine fibroids by synthesizing economic evaluations of various surgical techniques and contexts.
Methods. A systematic search was conducted in four databases, Web of Science, Embase, PubMed/MEDLINE, and Scopus for studies published between 1990 and 2025. Eligible studies included full or partial economic evaluations comparing myomectomy to alternative surgical procedures. Study quality was appraised using the Quality of Health Economic Studies (QHES) instrument. To ensure comparability across currencies and years, all costs were standardized to 2024 International Dollars using purchasing power parity (PPP) adjustments.
Results. Fourteen studies met inclusion criteria: ten (71.4%) cost analyses and four (28.6%) comprehensive economic evaluations. Most studies (78.6%) originated from the United States. Reported myomectomy costs varied substantially, ranging from $1,469 to $626,197 (2024 International Dollars), reflecting heterogeneity in surgical methods, healthcare settings, and analytical perspectives. Only 35.7% of studies achieved high methodological quality. Economic outcomes were significantly influenced by the analytical time horizon lifetime models generally favoured myomectomy over hysterectomy, while studies with shorter follow-up periods (≤5 years) often concluded the opposite. Robotic-assisted myomectomy was consistently more expensive ($57,283-$66,596) compared with conventional approaches ($28,721-$37,480). Methodological shortcomings included limited time horizons, unclear perspectives in 90% of cost analyses, and inadequate sensitivity or uncertainty analyses in half of the studies.
Conclusion. Myomectomy appears to be a cost-effective intervention from a lifetime perspective, particularly for women seeking fertility preservation. However, existing evidence is constrained by poor methodological quality and inconsistency in economic frameworks. Future research should adopt standardized evaluation models incorporating lifetime analytical horizons, clear perspectives, and comprehensive uncertainty assessments to strengthen evidence-based decision-making and ensure equitable access to fertility-preserving surgical care.
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