Costing Issues and UAE in the Developing World
Uterine Artery Embolisation (UAE), first described in France in 1995, rapidly became commonplace in many countries, but has had poor uptake in the developing world. Since 1998, I, along with local contacts and colleagues in Radiology and Gynaecology have
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Contents 1
Introduction.......................................................................... 149
2
UAE in the Caribbean ........................................................ 150
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UAE in East Africa ............................................................. 152
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UAE in the Developing World ........................................... 153
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Conclusion ............................................................................ 153
Abstract
Uterine Artery Embolisation (UAE), first described in France in 1995, rapidly became commonplace in many countries, but has had poor uptake in the developing world. Since 1998, I, along with local contacts and colleagues in Radiology and Gynaecology have been able to set up large scale UAE services in the Caribbean, based out of Trinidad and from 2009 have added UAE to a comprehensive ‘Fibroid centre’ in Kenya at the Aga Khan University Hospital, Nairobi. In each situation this has required a close working relationship with medical, hospital and political personnel. Financial considerations, careful case load selection and planning with robust preprocedural screening and imaging has been arranged as has very careful post-procedural care and follow-up. Over 1000 UAE cases have been performed in the Caribbean with very high success rates and no major complications nor deaths. Over 100 patients have now been treated in Kenya with a similar success rate and low complication rates. A mixture state-funded and private patients have been treated in both settings. The use of Gelfoam slurry as the embolic of choice in the majority and the avoidance of micro catheters wherever possible has led to an affordable procedure with costs equivalent to or less than hysterectomy in both settings.
References...................................................................................... 153
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N. Hacking (&) Southampton, UK e-mail: [email protected]
Introduction
Uterine Artery Embolisation (UAE), first described in France in 1995 (Ravina et al. 1995), rapidly spread through USA (Goodwin et al. 1997), the UK (Bradley et al. 1998), much of Europe (Golfieri et al. 2000; Lohle et al. 2001; Zupi et al. 2001), Canada (Pron et al. 2003a, b), but has had patchy take up in many European countries, Australasia the Middle and Far East as well as countries in the Developing World.
J. Reidy et al. (eds.), Radiological Interventions in Obstetrics and Gynaecology, Medical Radiology. Diagnostic Imaging, DOI: 10.1007/174_2014_1011, Springer Berlin Heidelberg 2014 Published Online: 20 May 2014
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Initially lack of evidence, lack of Gynaecological support and worries over costs, both financial and radiation, concerns over complication rates (Vashisht et al. 1999; Lanocita et al. 1999; Godfrey and Zbella 2001) and uncertainty over the effect on fertility were all cited as reasons for poor take up of the UAE procedure. In the UK the National Institute for Clinical Excellence (NICE), looked closely at UAE and issued guidance in 2004, 2007 and lastly in 2010 where they
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