Surgical Costs Associated with the Treatment of Uterine Fibroids
Hopkins, Thomas D
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Introduction Uterine fibroids, or leiomyomas, are benign tumors that arise from smooth muscle tissue in the uterine cavity and lining. The true prevalence of uterine fibroids is difficult to determine due to only symptomatic women presenting for treatment, however, a large scale study found that the self-reported prevalence in the United States (US) is about 6.9% and the age-standardized incidence rates of fibroids confirmed by ultrasound or hysterectomy were 9.2 per 1,000 person-years overall. There are many pharmacologic treatments that are approved and used in practice for the treatment of uterine fibroids, including: hormone contraceptives, gonadotropin-releasing hormone (GnRH) agonists, GnRH antagonists, among other less used agents. The mainstay of curative therapies are surgical procedures with hysterectomies being the true curative option. Therefore, the focus of this thesis was on the all cause long-term surgical procedure costs associated with each of the procedures. The surgical procedures addressed and analyzed in this study were open and laparoscopic hysterectomies, open and laparoscopic myomectomies, uterine artery embolization, magnetic resonance-guided focused ultrasound (MRgFUS), and endometrial ablation. There are differential rates in recurrence of uterine fibroids among the surgery types that could also require a re-intervention by a physician. Because of this, this study is designed to compare the costs among the different surgery types with different risks of re-intervention rates. Objective The primary objective of this study was to describe and compare the long-term all cause direct costs associated with subjects’ first surgical procedure for uterine fibroids of the seven surgical interventions or interventional radiology procedures. Methods A retrospective cohort study design was utilized to compare the long-term all cause costs associated with the seven major surgical types for the treatment of uterine fibroids in a large database with claims for the commercially insured population of the United States. Patients were described based on their first surgical procedure for the treatment of uterine fibroids. Multivariate regression analysis was utilized to determine the statistical significance of the differences of costs for the different surgical cohorts. All cause total costs, all cause medical costs, all cause pharmacy costs, all cause outpatient costs, and all cause inpatient costs were collected for the seven surgical cohorts over a nine-year time frame from 2008 through 2016. All cause total costs were the sum of all cause medical, all cause pharmacy, all cause outpatient, and all cause inpatient costs. Results 81,910 women were included in the study: total abdominal hysterectomy (21,796), laparoscopic hysterectomy (16,206), total abdominal myomectomy (4,889), laparoscopic myomectomy (25,504), uterine artery embolization (1,521), endometrial ablation (11,890), MRgFUS (105). The surgical cohort with the highest all cause total costs was the MRgFUS cohort ($90,992), followed endometrial ablation ($47,892), laparoscopic myomectomy ($47,219), laparoscopic hysterectomy ($41,703), total abdominal myomectomy ($28,044), and total abdominal hysterectomy ($25,791). The all cause total costs surgical costs were statistically significantly different from another. Discussion This study provides insight on the differences in overall long-term costs that are associated with the first surgical procedure chosen by women with uterine fibroids. This information can be used to better inform decision-making for clinicians, patients, and payers. Given the small number of participants in the MRgFUS surgical cohort, further research should be performed to better describe patients who pursue this treatment option. Conclusions Uterine fibroid surgery using MRgFUS had the highest all cause total costs among seven different surgical cohorts. Future research should be performed to determine the impact that re-intervention has on total costs.