Characterization of Hysterectomy/Uterine Ablation Rates in VWD and Undiagnosed Bleeding Using Claims Data [32G

Abstract

INTRODUCTION: Heavy menstrual bleeding (HMB) is common in women and adolescents post menarche, in some cases resulting in hysterectomy or uterine ablation. Based on retrospective studies 10-62% of women with HMB may have an underlying bleeding disorder (BD), such as von Willebrand Disease (VWD), the most common bleeding disorder. Despite public awareness campaigns, a diagnosis of a potential bleeding disorder is often missed or significantly delayed. Here we characterize the rates of hysterectomy/uterine ablation in a symptomatic undiagnosed (SUD) vs. symptomatic diagnosed VWD (SVWD) population. METHODS: We utilized the IMS Health Real-World Data Adjudicated Claims, looking at patients continuously enrolled for 2+ years (July 2013 ‒ July 2015) with 1+ severe bleed or 2+ bleed claims. These symptomatic patients were classified based on presence (SVWD; n=837) or absence (SUD; n=2,760) of a VWD diagnosis claim. RESULTS: The incidence of hysterectomies/uterine ablation was similar between the SUD vs. the SVWD patients (5.9% and 7.3% respectively). However, the mean age at the time of hysterectomy was significantly (P < 0.05) younger in SUD (35 years) versus the SVWD patients (42 years). 8% of the procedures performed in the SUD occurred in patients 18-25 years old versus 1% in the SVWD patients. CONCLUSION: Treatment options for HMB require an evaluation of the etiology, which may be, in many cases, an underlying BD. A timely diagnosis of VWD allows patients access to therapies specifically targeting VWD, including antifibrinolytics, DDAVP and factor replacement, potentially avoiding or delaying the need for more terminal therapies such as hysterectomy/uterine ablation.