Private Payer Perspective Research Articles

35: Repeat Procedures and Economic Outcomes Post-Endometrial Ablation of Patients with Dysfunctional Uterine Bleeding (Dub)—A Private Payer Perspective

To determine repeat procedure rates among dysfunctional uterine bleeding (DUB) patients undergoing endometrial ablation and their associated economic costs. Retrospective private payer claims database analysis of DUB patients undergoing endometrial ablation. Patients were followed for 2 years to determine repeat procedures and economic costs. National-level database of claims from more than 20 private payers. Two hundred sixty women 18+ years of age with DUB undergoing an endometrial ablation between January 2000 and December 2001 and no ablation or hysterectomy procedure 1 year prior. Initial endometrial ablation procedure; repeat endometrial ablation and follow-up hysterectomy procedures. Of the 260 ablation patients, only 17 (6.5%) required a second procedure during the 2-year follow-up. There were no statistical differences in age or co-morbid conditions between patients with and without a repeat procedure. The mean time between the initial and first repeat procedure was 304 days. Twelve patients had a follow-up hysterectomy, 4 had a repeat ablation, and 1 patient had a repeat ablation followed by a hysterectomy. Roughly half of these patients underwent the second procedure for excessive menstruation. Patients with a repeat procedure had significantly higher overall and DUB-related health resource use over 2 years. Mean DUB-related medical costs for all ablation patients were $2,578 (SD $3,593). Patients with a repeat procedure averaged $8,583 versus $2,158 for those with no repeat procedure (p<0.001). Inpatient hospitalizations ($4,357 vs. $319, p<0.001) and professional services ($2,895 vs. $1,043, p<0.001) comprised the majority of these costs. Total overall medical costs also were significantly higher among patients with a repeat procedure ($17,811 vs. $10,327, p<0.001). DUB patients undergoing endometrial ablation experienced very low rates of repeat procedures. Patients with a repeat procedure had significantly higher inpatient and professional costs than those with no repeat procedure. Endometrial ablation appears to be an effective and durable, less-invasive treatment for DUB.