PIH12 - Employer-Perspective Cost Comparison of Surgical Treatments for Abnormal Uterine Bleeding

Abstract

Abnormal uterine bleeding (AUB) affects women’s health and work productivity. Cost comparison analyses for surgical treatment of AUB from a self-insured employer perspective have not been undertaken. Employer-paid insurance claims data were analyzed to estimate direct and indirect costs associated with surgical treatment of AUB with global endometrial ablation (GEA), outpatient hysterectomy (OPH), and inpatient hysterectomy (IPH). The Truven Health MarketScan Commercial and Health and Productivity Management Databases were used to identify female employees aged 30-55 years with AUB who had GEA, OPH, or IPH during 01/01/2013–6/30/2015. Direct costs included costs of AUB surgical intervention, complications, and reintervention (for GEA patients), along with all other healthcare costs incurred one year post-surgery. Indirect costs of absenteeism and short-term disability (STD) were calculated using a wage constant ($23.88/hour) specific to women in the age group. A subset of analyses disaggregated results by 10 employer type classifications. All costs were 2017 US $. Total one-year healthcare costs paid by employer insurance for women with surgical AUB treatment were $14,715 for GEA, $22,425 for OPH, and $24,749 for IPH (direct cost ∆: $7,709–$10,033). Gynecology-related costs also were comparatively lower for GEA treatment. Costs varied when disaggregated by industry type; largest cost savings for GEA vs. OPH and IPH were for patients employed in “Agriculture/Forestry/Fishing” and “Finance, Insurance, Real Estate.” Work absence was 8.7 days less for GEA vs. OPH and 10.8 days less for GEA vs. IPH (indirect cost ∆: $1,665–$2,068). STD work days lost were 13.1 days less for GEA vs. OPH and 13.2 days less for GEA vs. IPH (indirect cost ∆: $2,500–$2,519). Study results suggest strong financial favorability for GEA vs. OPH or IPH from an employer perspective and should help inform self-insured employers seeking cost-effective AUB treatments.