Background Uterine fibroids cause significant morbidity, psychosocial stress, and poor quality of life due to symptoms including heavy menstrual bleeding, anemia, pain, and bulk symptoms, as well as reproductive complications including infertility, early pregnancy loss, and preterm birth. Fibroids represent a 42.2 billion USD annual economic burden to the United States healthcare system. Despite reported delays in diagnosis of fibroids even in symptomatic women, clinical guidelines do not recommend screening for fibroids. High risk patient groups are well known. Earlier detection of fibroids through ultrasound screening could allow for earlier intervention with secondary prevention strategies or less invasive treatment options and improve the quality of life of women living with fibroids.

Objective The study aimed to evaluate the cost-effectiveness of annual ultrasound screening for fibroids in women aged 25-54 years in the United States.

Study Design In this economic evaluation, conducted in January-February 2026, a decision-analytic Markov model was developed using a healthcare payer perspective to analyze the cost-effectiveness of ultrasound screening for women in the United States. The time horizon was 25 to 55 years of age. Costs were adjusted for inflation to 2025 average according to the yearly medical care index of the United States consumer price index. Discounting (3% per cycle) and half-cycle corrections were calculated. Deterministic and probabilistic sensitivity analyses were performed to explore uncertainty, analyzed using TreeAge Pro Healthcare software. Model variables were obtained from published literature. All women residing in the United States aged 25-54 years were assumed to have been invited to the screening program.

Results Ultrasound screening for fibroids for women was found to be not only cost-effective but also cost-saving, with an incremental cost-effectiveness ratio (ICER) of -$56,605.631 per QALY (quality-adjusted life-year) gained in the base-case analysis, at a willingness to pay threshold of $30,000 per QALY. Ultrasound screening was cost-effective at all starting ages from 25 to 54 years, with even greater benefit at younger ages. Sensitivity analyses demonstrated the robustness of these findings across a wide range of variable ranges. Ultrasound screening for fibroids showed a cumulative potential to save $1,169 billion and increase 20.7 million QALYs per year compared to no screening for a population of 63.89 million American women between 25 and 54 years old. The subset of 9.32 million Black American women experienced greater benefits, with potential savings of 183 billion and an increase of 3 million QALYs.

Conclusion Based on the model-based analysis, annual ultrasound screening for uterine fibroids for women aged 25-54 years in the United States was cost-effective and cost-saving, even more so for Black women. These model-based findings highlighted the potential value of guidelines for annual ultrasound screening for fibroids, which could enable earlier diagnosis, secondary prevention, and timely intervention, with positive impact on both quality of life and healthcare costs.

Tweetable Statement Annual ultrasound screening for uterine fibroids in U.S. for women aged 25–54 years was cost-effective and cost-saving.

A. Why was this study conducted?

B. What are the key findings?

Annual ultrasound screening beginning at 25 years was both cost-effective and cost-saving, with an ICER of –$56,605.631/QALY for women in the US.

Screening resulted in potential savings of $1,169 billion for US healthcare payers and 20.7 million QALYs for U.S. women.

C. What does this study add to what is already known?

Annual ultrasound screening for fibroids is not only cost effective but also cost saving, highlighting its potential to reduce diagnostic delays and enable earlier, less invasive interventions.

The results support development and implementation of fibroid screening guidelines.

The authors have declared no competing interest.

This research was funded, in part, by the Howard and Georgeanna Seegar Jones Endowment to JHS.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

PubMed and Embase. The full data is available in the supplementary items of the manuscript.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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The decision tree used for the cost-effectiveness evaluation has been shared in Figure 1 and Figure C.1. The model parameters used and all the derivations and other calculations of values have been shared in Table 1 and Appendix B.