Abstract
Hysterectomy, the driving force for symptomatic uterine fibroids since 1895, has decreased over the years, but it is still the number one choice for many women. Since 1995, uterine artery embolization (UAE) has been proven by many researchers to be an effective treatment for uterine fibroids while allowing women to keep their uteri. The preponderance of data collection and research has focused on care quality in terms of efficiency and effectiveness, with little on location and viability related to care utilization, accessibility and physical availability. The purpose of this study was to determine and compare the cost of UAE and classical abdominal hysterectomy with regard to race/ethnicity, region, and location. Data from National Hospital Discharge for 2004 through 2008 were accessed and analyzed for uterine artery embolization and hysterectomy. Frequency analyses were performed to determine distribution of variables by race/ethnicity, location, region, insurance coverage, cost and procedure. Based on frequency distributions of cost and length of stay, outliers were trimmed and categorized. Crosstabs were used to determine cost distributions by region, place/location, procedure, race, and primary payer. For abdominal hysterectomy, 9.8% of the sample were performed in rural locations accross the country. However, for UAE, only seven procedures were performed nationally in the same period. Therefore, all inferential analyses and associations for UAE were assumed for urban locations only. The pattern differed from region to region, regarding the volume of care (numbers of cases by location) and care cost. Comparing hysterectomy and UAE, the patterns indicate generally higher costs for UAE with a mean cost difference of $4223.52. Of the hysterectomies performed for fibroids on Black women in the rural setting, 92.08% were in the south. Overall, data analyzed in this examination indicated a significant disparity between rural and urban residence in both data collection and number of procedures conducted. Further research should determine the background to cost and care location differentials between races and between rural and urban settings. Further, factors driving racial differences in the proportions of hysterectomies in the rural south should be identified to eliminate disparities. Data are needed on the prevalence of uterine fibroids in rural settings.
Highlights
IntroductionStudies indicate that 30% to 50% of women 25 years to 49 years old, and 50% of menopausal women in the U.S.A were susceptible to developing uterine fibroids that needed medical attention [1,2,3]
(9.257 times that of rural hysterectomies), the largest number being in the urban south at 48,870, while 12,756 were performed in the rural setting (47.8% in the south region), with an overall mean cost of $17,555.39 in urban settings, and $13,838.59 in the rural
A total of 1943 uterine artery embolization (UAE) procedures were performed in the urban setting, with only 5 (7 before trimming) in the rural areas (3 northeast and 2 south); rural UAEs were excluded from further analyses due to very low numbers (Table 1)
Summary
Studies indicate that 30% to 50% of women 25 years to 49 years old, and 50% of menopausal women in the U.S.A were susceptible to developing uterine fibroids that needed medical attention [1,2,3]. Cain-Hielsen et al [4] reported a cumulative incidence of uterine fibroids of 70% among white women and over 80% among African American women. After a diligent search of the literature, the epidemiological distribution of the prevalence of uterine fibroids in the U.S has not been reported with regard to its distribution by rural/urban patterns. It is apparent that literature indicating the prevalence of uterine fibroids has been mostly based on research data from 1997 through to 2002
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