A case-controlled cost and clinical outcomes analysis comparing transvaginal radiofrequency conservative treatment of uterine myomas and surgical treatment by myomectomy or hysterectomy in a teaching hospital.

CONTEXT: Surgical options for symptomatic uterine myomas include myomectomy (fertility-sparing), hysterectomy (radical surgery) and uterine artery embolization (conservative with questions about fertility). Myolysis (including radiofrequency ablation) which uses thermal energy, is an emerging minimally invasive alternative. The aim of this study was to perform a cost analysis comparing transvaginal radiofrequency ablation and traditional surgeries for uterine myomas.

METHODS

This single-center, retrospective, case-control and age-stratified cost analysis study included women who underwent transvaginal radiofrequency ablation for uterine myomas in a teaching hospital between October 2022 and June 2024. Matched controls included women under 42 who underwent open or laparoscopic myomectomy, and women over 42 who underwent open or laparoscopic hysterectomy. Cost, clinical outcomes, and complications were analyzed and compared between groups.

RESULTS

A total of 73 radiofrequency ablation were performed: 48 in women under 42 and 25 in women over 42. Regardless of age group, radiofrequency ablation resulted in shorter surgical duration and hospital stay, as well as reduced blood loss. The total cost of the procedure, including the price of the non-reusable electrode, was significantly lower in the radiofrequency ablation group. The initial sick leave was significantly shorter in the radiofrequency ablation group (mean sick leave: 3.9 to 4.8 days for radiofrequency ablation vs 26.4 to 30.6 days for open or laparoscopic myomectomy or hysterectomy). Risk of readmission or reintervention were comparable between groups.

CONCLUSION

Radiofrequency ablation emerges as a promising, less invasive alternative to conventional surgery for the first-line treatment of symptomatic uterine fibroids, offering a lower overall cost.