Professor Klim McPherson

Visiting Professor in Epidemiology
McPherson Group
Epidemiological methods and women’s health

Publications

Contact address NDOG, Level 3, Women's Centre, John Radcliffe Hospital, Oxford, Oxfordshire, OX3 9DU, United Kingdom
Department Nuffield Department of Obstetrics and Gynaecology
College New College
Professor Klim McPherson

Prof Klim McPherson

Recent Research project: HOPEFUL Study

Treatment for Symptomatic Uterine Fibroids: Uterine Artery Embolisation (UAE) or Hysterectomy (HOPEFUL: "Hysterectomy Or Percutaneous Embolisation For Uterine Leiomyomata?")

The hysterectomy cohort (VALUE group) are being coordinated by Mike Maresh, Consultant in Obstetrics and Gynaecology, St Mary’s Hospital for Women and Children, Whitworth Park, Manchester, M13 0JH

The UAE cohort are being coordinated by Tony Nicholson, Consultant Vascular Radiologist, Radiology Dept, Jubilee Building, Leeds General Infirmary, Leeds, LS1 3EX

Health Economists:  Professor Andy Briggs and Dr Olivia Wu, University of Glasgow

Aims

Uterine Artery Embolisation (UAE) is a novel treatment for symptomatic fibroids, a less invasive alternative to the currently available surgical methods of hysterectomy and myomectomy. The Joint Working Party of the RCOG has drawn attention to the lack of medium to long-term data that compares UAE with surgical options for symptomatic fibroids and has emphasised the need for randomised comparisons. Fully informed randomisation between major surgery, which terminates reproductive function, and an intervention which deals with the specific cause of symptoms, is problematic. This project seeks to systematically collate and enhance existing clinical databases in the UK to provide comparable preliminary data in an observational setting, based on clinical practice experienced thus far. Women need to be able to balance the benefits of the two procedures with their disadvantages based on the best information available. Presently, UAE treatment is offered according to the preferences of the specialist units and availability to eligible patients, without any clear methodology for assessing its benefits and costs compared with hysterectomy. This study aims to compare the efficacy, safety and cost-effectiveness of the two treatments.

Methods

The project is a comparative analysis of two cohorts of women with symptomatic fibroids treated since 1994 either by UAE or hysterectomy, with several years’ retrospective follow-up. It is a multi-centre study involving 18 collaborating hospital centres within England and Scotland. (Details of participating centres are given below). This is the only systematic epidemiological study of the two competing treatments for symptomatic fibroids with long-term follow up. The study sample consists of over 1000 women; approximately half were treated with embolisation and half with hysterectomy. Ten patron radiologists, pioneers of UAE for fibroids, agreed to provide a complete list of all their patients on whom UAE had been performed providing the opportunity to collect clinical data on around 600 UAE procedures. The control/hysterectomy cohort comes from the VALUE Study (1) which is investigating long-term effects of 37,000 unselected hysterectomies carried out between October 1994 and October 1995 in the UK, except Scotland.  This group was initially recruited as a control group for women treated with trans-cervical endometrial ablation for dysfunctional uterine bleeding (DUB).  Amongst them, there were about 6000 women with uterine fibroids as the first indication and comprehensive clinical and operative data is available for them. From this group of 6000, around 1000 patients were treated in 12 VALUE centres that have performed the most hysterectomies for fibroids. Nine of these VALUE centres collaborated in HOPEFUL. These patients are not part of the existing VALUE follow up protocol, which is concerned with patients with menorrhagia as the main indication.

The Results of the HOPEFUL study are now published:

Susan Dutton, Allison Hirst, Tony Nicholson, Michael Maresh, Klim McPherson. A large UK multi-centre retrospective cohort study comparing hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids (HOPEFUL Study): main results on long-term safety and efficacy. BJOG. 2007 Nov; 114(11):1340-51.

Olivia Wu, Andrew Briggs, Susan Dutton, Allison Hirst, Michael Maresh, Anthony Nicholson and Klim McPherson. Uterine Fibroid Embolisation for the treatment of  symptomatic uterine fibroids: a cost utility analysis of the HOPEFUL study. BJOG     2007 Nov; 114(11):1352-62.

Hirst A,  Dutton S,  Wu O, Briggs A, Edwards C,  Waldenmaier L,  Maresh M,  Nicholson A,  McPherson K.  A multi-centre retrospective cohort study comparing the efficacy, safety and cost-effectiveness of hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids. (The HOPEFUL study.)    Health Technol Assess. 2008 Mar;12(5):1-248

Biography

Professor Klim McPherson is the Chair of the National Heart Forum, an alliance of health related NGOs concerned to prevent premature mortality from cardiovascular disease and other chronic conditions (www.heartforum.org.uk).  He has a Visiting Professorship in the Nuffield Department of Obstetrics & Gynaecology, and is a Fellow of New College, Oxford University (www.new.ox.ac). His research is in epidemiological methods and women’s health. He runs an option in Health & Disease for final year undergraduates in Human Sciences, and teaches in Obstetrics and Gynaecology.

His current commitments are: Chair of the NICE CVD Population Program Development Group reporting late in 2009, member Expert Advisory Group on Women’s Health of MHRA and a past member of the Public Health Interventions Advisory Committee of NICE and their Heavy Menstrual Bleeding guideline development group. He has served as an expert advisor on the Advisory Council on the Misuse of Drugs.

He was co-author of the recent Foresight Report on Tackling Obesities - Future Choices with Government Office for Science, for which he was responsible for epidemiological modelling[1] (www.foresight.gov.uk). He is currently on the expert working group advising the Cross Government Strategy on obesity prevention. With the National Heart Forum he has a research group examining the role of micro simulation in better understanding public health interventions.

He is a member of the Legal and General’s Longevity Science Advisory Panel chaired by Sir Derek Wanless. He has chaired the British Breast Group, the European Public Health Association and the Society for Social Medicine among other research bodies.

Professor McPherson’s particular interests are coronary heart disease prevention and the causes of breast cancer, particularly the health implications of hormone replacement therapy (HRT). He has a longstanding research interest in the treatment of women with menstrual problems, particularly conservative methods of treating uterine fibroids in order to retain or enhance fertility. He has some 400 peer reviewed publications in academic journals. He is concerned with public health policy as it affects primary prevention of disease.


[1]   McPherson K, Marsh T, Brown M (2007) Tackling obesities: future choices—modelling future trends in obesity and their impact on health. Report for Foresight. Government Office of the Chief Scientist.: www.foresight.gov.uk.

 Butland B, Jebb S, Kopelman P, McPherson K, Thomas S, et al (2007 ) Tackling obesities: future choices - Project report.