03:27 PM Abstract No. 261 National variation in management of symptomatic uterine fibroids in contemporary clinical practice

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.