Abstract
To evaluate national variation in the utilization of various invasive therapies in the management of symptomatic fibroids Using Truven Health MarketScan® Commercial Claims and Encounters database and International Disease Classification version 9 codes, women aged 18-55 with symptomatic and clinically significant uterine fibroids (UF) from 2009-2015 were identified. Clinically significant UF was defined as patients who had at least one insurance claim with a UF diagnosis code for an inpatient stay or emergency department visit or at least two outpatient visit claims with a UF diagnosis code at least 30 days or more apart. Patients who underwent hysterectomy, myomectomy, endometrial ablation, and uterine fibroid embolization (UFE) were identified using Current Procedural Terminology codes. Chi-squared tests were performed to identify the clinical setting, demographic and geographic determinants of receiving therapies. Overall, 838,620 patients with symptomatic fibroids were identified. Menorrhagia (52%), pelvic pain (38%), and urinary symptoms (25%) were the most prevalent reported symptoms. Invasive therapy was performed on 369,465 (44%):79% underwent hysterectomy, 13% endometrial ablation, 4% myomectomy, and 4% UFE. Hysterectomy was performed as an inpatient procedure in 60% of cases vs. 40% in outpatient or ambulatory settings. In contrast, UFE was typically performed as an outpatient or office setting procedure (89%). Patients in rural areas had significantly higher chances of undergoing hysterectomy or endometrial ablation when compared to UFE or myomectomy (p<0.001). Of those undergoing UFE, the majority were <45 years (7.6% of the entire cohort) vs. 0.9% for those ≥45 years (p<0.001). Significant statewide variation was observed in the type of therapy the patients underwent. Specifically, utilizations rate of UFE ranged from 0.3% to 14.9% in Wyoming and District of Columbia respectively. Compared with other invasive procedures for symptomatic clinically significant uterine fibroids, the utilization of UFE is low, with marked state-to-state variation. Younger women living in urban areas are more likely than others to undergo UFE.
Published Version
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