Analysis shows steep costs for uterine fibroid and heavy menstrual bleeding treatment

Uterine fibroids (UF) with heavy menstrual bleeding (HMB) pose a significant economic burden—mostly due to surgical and procedural costs and treatment, according to a claims analysis in the Journal of Women’s Health.

Women in the study, aged 18 to 51, appeared in the IBM MarketScan Commercial Claims and Encounters Database between October 2007 and September 2018, and were matched by demographics and Charlson Comorbidity Index (CCI) score.

Before matching, the study sample consisted of 3,377,957 women, with a mean age of 36.7 years, of whom 7% had UF only, 18% with HMB only, 8% with UF+HMB, and 66% with neither diagnosis as controls.

Women diagnosed with UF+HMB represented 54% of all women with UF and 31% of those with HMB.

Women with UF—regardless of a diagnosis of HMB—were typically older. For instance, more than 70% in the UF + HMB and UF-only cohorts were between the ages of 39 and 51 compared with less than 50% of this age range in the HMB-only and control cohorts.

During the pre-index year, about 25% of patients in the matched cohorts of UF only, HMB only and UF + HMB had received any UF and/or HMB-related treatments.

Conversely, during the post-index year, treatment was initiated in 61% of women with UF + HMB, 44% in the HMB-only group and 27% in the UF-only group.

Surgeries and procedures were performed in 48% of the previously untreated UF+HMB cohort, compared to 24% in the HMB-only cohort and 17% in the UF-only cohort.

Of those who had surgeries/procedures during the post-index year, 12% had medications and 37% had 0 medications, while 18% received medications only.

However, following diagnosis, 20% of previously untreated women with HMB only were managed with medications versus 10% of those with UF only.

Among the subgroups with baseline contraceptive use, 53% of the UF+HMB subgroup were treated with surgeries/procedures, followed by 25% in the HMB-only and 19% in the UF-only subgroups.

But just 35% of this UF+HMB subgroup were treated with solely medications compared to 56% in the HMB-only and 62% in the UF-only subgroups.

In the UF+HMB subgroup using contraceptives before diagnosis, 12% had 0 treatments during the post-index period versus 19% each in the UF only and HMB only subgroups.

Costs were calculated using the value of US dollars in 2018 during the post-diagnosis year.

The mean all-cause total costs for UF+HMB exceeded that of the UF only group by 24%: $16,762 vs. $13,506, respectively.

More striking was that mean total costs for UF+HMB were 50% higher than for the $11,135 incurred by the HMB-only cohort and nearly triple the $6,691 for the control cohort; All mean all-cause total cost comparisons were P < 0.001.

In addition, the mean diagnosis-related costs were significantly higher for UF+HMB than for either UF-only or for HMB-only groups—$8,741 vs. $4,550 versus $3,081, respectively (all, P < 0.0001).

Overall, surgery/procedure costs represented 80% of diagnosis-related medical costs for UF+HMB patients

“While surgical and procedural costs contribute substantially to diagnosis-related medical costs, effective pharmacological strategies can alleviate the clinical burden of symptomatic UF, particularly HMB, by reducing surgeries and procedures, thus ameliorating associated health care costs,” wrote the authors.

Reference

  1. Wang A, Wang S, Owens CD, et al. Health care costs and treatment patterns associated with uterine fibroids and heavy menstrual bleeding: a claims analysis. J Womens Health (Larchmt). Published online September 30, 2021. doi:10.1089/jwh.2020.8983