Presentation (CTI)

OBJECTIVES: Intrauterine adhesions (IUAs) can result from endometrial trauma, most commonly following intrauterine surgery (IUS), and typically are treated with hysteroscopic adhesiolysis (HA). Even in those with apparent successful adhesiolysis, infertility may remain, and for those who do conceive, there may still be detrimental obstetrical and fetal outcomes. We sought to quantify the economic burden experienced by women with a history of IUAs and HA through their association with infertility by comparing the infertility-related economic costs of three cohorts of women: Those with a history of HA, those with a history of other IUS, and those without a history of IUS.
METHODS: We conducted a retrospective analysis of a closed claims database to identify healthcare resource use and costs for women with at least 6 months of continuous enrollment in each of the three cohorts of interest. The analysis was restricted to the eight US states where coverage for in vitro fertilization (IVF) and embryo transfer (ET) services had been mandated before 2017. We used propensity-score matching (PSM) to reduce confounding among the three cohorts, which were analyzed over a period of 41 months.
RESULTS: Following PSM, our analysis included 594 patients in each cohort. The total costs of infertility evaluation and management were $1,488,373 ($2,506/woman) in the cohort with a history of HA, $259,360 ($408/woman) among the cohort with prior uterine procedures that didn’t include HA, and $40,136 ($68/woman) for women with no history of IUS.
CONCLUSIONS: Women who underwent hysteroscopic adhesiolysis were found to have greatly increased use of healthcare services for infertility evaluation and management, primarily IVF-ET. These data suggest that existing endometrial trauma may not be addressed by HA, an observation that supports the need for measures that minimize or prevent endometrial trauma and associated IUAs when providing care to women with intrauterine conditions.