Power morcellation procedures for hysterectomies are more cost-effective than other procedures used to remove uteruses, according to a study published in The Journal of Minimally Invasive Gynecology, but the risk of spreading and worsening undiagnosed uterine cancer makes using the devices a dangerous cost-saving option.
Power morcellation uses a medical device fitted with a long blade that minces the entire uterus or uterine fibroids inside the abdominal cavity and removes them through a small incision. The procedure has been preferred by doctors over open surgeries not only because it is more cost-effective, but also because it is less invasive, leaves less scar tissue, and offers shorter recovery. About 50,000 power morcellation procedures for hysterectomies or myomectomies – the removal of uterine fibroids – have been performed each year in the United States.
However, opinion changed during the past year when advocates began pushing the Food and Drug Administration (FDA) to ban the devices due to the risk of spreading a rare form of uterine cancer known as uterine sarcoma. It is difficult to detect the cancer without first removing the tissue or uterus. Concerns were raised that during power morcellation, bits of cancerous tissue were being strewn around the abdominal cavity, seeding new tumors and making the cancer more difficult to treat.
While uterine sarcoma is rare, the FDA did find that power morcellation could spread undetected cancer and worsen a woman’s odds of survival. The agency issued a safety communication discouraging the use of power morcellation in most women.
Since then, several health insurers have announced they will require pre-approval before paying for power morcellation procedures. Medical device groups, however, are grappling with a way to justify the devices amid the negative opinion.
Researchers with Northwestern University Feinberg School of Medicine found that non-morcellation hysterectomy using laparotomy (averaging $30,359.92) cost more than morcellation hysterectomy (averaging $20,853.15) by more than $10,000. When looking from a purely cost perspective, researchers noted, “Eliminating morcellation hysterectomy as a treatment for fibroids is not cost-effective under a wide variety of probability and cost assumptions. Performing laparotomy for all patients who might otherwise be candidates for morcellation hysterectomy is a costly policy from a societal perspective.”
This argument was countered by Dr. Hooman Noorchashm and his wife, Dr. Amy Reed, who are among those who spearheaded the campaign against power morcellation after Reed was diagnosed with advanced uterine sarcoma shortly after undergoing power morcellation for the removal of uterine fibroids. “Basically, this is … making a financial argument to justify something … that places the lives of the minority subset of women in deadly harm’s way. That is ethically blind,” Noorchashm said.