Healthcare Cost and Utilization of Uterus-Sparing Interventions in Women with Uterine Fibroids: A Retrospective Claims Analysis

Abstract

<h3>Study Objective</h3> To describe peri-operative costs and healthcare utilization of four uterus-sparing interventions used to treat women with intramural and/or subserosal uterine fibroids. <h3>Design</h3> Retrospective US insurance claims analysis. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> The IBM MarketScan® Commercial Database was queried to identify 37,730 women with no history of gynecology cancer who underwent a uterus sparing procedure for fibroids between 1/2014-7/2021. Of those, 15,557 patients underwent abdominal myomectomy (AM), 11,896 underwent laparoscopic myomectomy (LM), 9,158 underwent uterine artery embolization (UAE), and 270 underwent laparoscopic radiofrequency ablation (LAP-RFA). The mean age was 36.6 for women undergoing AM, 37.4 for LM, 41.2 for LAP-RFA, and 44.7 for UAE. <h3>Interventions</h3> Abdominal and laparoscopic myomectomy, UAE, LAP-RFA. <h3>Measurements and Main Results</h3> Median perioperative costs, defined as patient out-of-pocket cost and insurance payments, were $11,710 (IQR $7,907, $18,762) for LAP-RFA, $13,774 (IQR $9,132, $21,890) for LM, $15,830 (IQR $11,265, $21,915) for AM and $15,877 (IQR $10,398, $24,193) for UAE patients. Eighty-one percent of AM patients required hospital admission post-operatively, compared with 7% of UAE, 6% of LM, and 1% LAP-RFA patients. Less than 10% of patients had an ER visit within 30 days after the procedure (8% for UAE, 6% for all other interventions). The 1-year re-intervention rate of any subsequent procedure (AM, LM, LAP-RFA, UAE, or hysterectomy) was lowest in AM group (3%) followed by LM (8%), LAP-RFA (9%), and UAE (9%). The 2-year re-intervention rate was 5% for AM, 10% for LM (10%), 12% for UAE and 13% for LAP-RFA. <h3>Conclusion</h3> The 3 minimally invasive approaches had similar rates of re-intervention at 2 years (10-13%). AM was associated with the lowest re-intervention rate (5%) but also the highest rate of post-operative admissions. LAP-RFA was associated with the lowest peri-operative cost, and UAE was associated with the highest peri-operative cost. Further studies are needed to assess the cost, effectiveness, and patient satisfaction with each procedure.