MR-HIFU: a choice to make for women suffering from uterine fibroids? Effectivity and societal impact of uterine fibroid MR-HIFU

Abstract

Although the MR-HIFU treatment of uterine fibroids have been available for over 20 years, still most women worldwide, including the Netherlands, have no access to this noninvasive treatment option. In this thesis some of the remaining hurdles were addressed.

PART 1: EFFECTIVITY OF GYNECOLOGICAL AND REPRODUCTIVE OUTCOMES In chapter 2 we evaluated the results of uterine fibroid MR-HIFU that were available at this point. Our work differed from previous work since we only included studies without a restricted treatment protocol. This means that the studies aimed for a complete treatment and we showed that this resulted in more decrease of uterine fibroid related symptoms and less re-interventions. Long-term data is however still missing.

In chapter 3 we commented on previous work on reproductive outcomes after different uterine fibroid treatments. Since factors like maternal age can influence pregnancy changes alongside the presence of a uterine fibroid or treatment effect, one should be careful whenpublishing data without taking this in consideration.

In chapter 4 previous studies were analyzed as well, however this time solely focusing on reproductive outcomes. An important advantage of (MR-) HIFU treatment is the fact that a pregnancy afterwards is possible. We showed complications did not occur more often in women treated by (MR-) HIFU. Whether (MR-) HIFU results in more pregnancies for women suffering with uterine fibroids, is however still unknown due to the limited number of pregnancies reported.

PART 2: MEASURES TO IMPROVE EFFECTIVITY In chapter 5 the contribution of a uterus stimulant to treatment efficiency was evaluated. When a uterus stimulant is administered, contractions of the uterus result in less blood flow in the tissue that needs to be treated. The aimed temperature can be reached more quickly, resulting in more efficient treatments. In our article we were able to prove this effect on a treatment cell level instead of a patient level.

In chapter 6 we reflected on the implementation of uterine fibroid MR-HIFU in our own non-academic hospital. We evaluated all the hurdles we needed to overcome on different levels and gave insight on the learning-curve of 25 treatments one should consider when performing uterine fibroid MR-HIFU due to the technical difficulties of the treatment.

PART 3: SOCIETAL IMPACT In chapter 7 we are aiming to overcome the most important hurdle for clinical implementation: the lack of reimbursement. Due to the lack of randomized-controlled trials on long-term effectiveness of uterine fibroid MR-HIFU, no reimbursement is reached in the Netherlands. By performing the MYCHOICE study, of which the study protocol can be found in chapter 7, we aim for clinical implementation and reimbursement.

In chapter 8 we took another look at the future and took the first step in performing a Life Cycle Assessment of a MR-HIFU treatment to get insights in the sustainability of this treatment. At this point, unfortunately not all necessary data is available to perform a full Life Cycle Assessment. We did however inventoried what would be necessary and focused on the importance to perform such analyses.