ECONOMIC AND CLINICAL OUTCOMES AMONG WOMEN WITH ABNORMAL UTERINE BLEEDING TREATED WITH INPATIENT OR OUTPATIENT HYSTERECTOMY VERSUS ENDOMETRIAL ABLATION
Author(s)
Bonafede M1, Tran O2, Miller JD3, Pohlman SK4, Vilalta A4, Troeger KA4
1IBM Watson Health, Brentwood, NH, USA, 2IBM Watson Health, San Francisco, CA, USA, 3IBM Watson Health, Cambridge, MA, USA, 4Hologic, Inc., Marlborough, MA, USA
OBJECTIVES: To describe economic and clinical outcomes among women with abnormal uterine bleeding (AUB) treated with global endometrial ablation (GEA) versus hysterectomy. METHODS: Women undergoing GEA or hysterectomy (index event) between 1/1/2012 and 4/30/2017 with ≥2 non-diagnostic claims indicating AUB before or on the index date in the IBM MarketScan® Commercial Database. Women were required to have 12 months pre- and post-index continuous enrollment. Outcomes included initial procedure and follow-up total healthcare costs and the incidence of complications. Re-intervention, defined as second GEA or hysterectomy, was reported up to five years post-index among GEA patients. RESULTS: 117,801 women met the inclusion criteria (56.6% GEA, 43.4% hysterectomy). The majority of hysterectomy cases (84.0%) occurred in an outpatient setting. Mean age was slightly lower for GEA patients (42.7 vs. 43.2, p<0.001). Total healthcare costs during the 12-month pre-index were lower for GEA than hysterectomy ($7,291 vs. $8,847, p<0.001). Total healthcare costs in the first month post-index among GEA patients were less than one-half of hysterectomy ($7,018 vs. $15,402, p<0.001), a similar finding when limited to inpatient ($17,672) or outpatient hysterectomy ($14,971) (both p<0.001). Total costs over the entire first year of follow-up were likewise lower for GEA than hysterectomy ($13,719 vs. $6,282) for both inpatient ($24,497) and outpatient ($21,149) hysterectomy (all p<0.001). Complications were more common among inpatient and outpatient hysterectomy than GEA patients (22.2% and 16.8% vs. 5.0%, both p<0.001). Among GEA patents, the rates of re-intervention declined from 5.5% to 2.2% from 1st to 5th year post-index; the cumulative re-intervention rate was 16.8% over 5 years. CONCLUSIONS: This analysis of a large, national administrative claims database found that GEA was approximately one-half the cost of hysterectomy for the treatment of AUB with fewer complications and low re-intervention rates over a 12-month follow-up period.
Conference/Value in Health Info
2019-05, ISPOR 2019, New Orleans, LA, USA
Value in Health, Volume 22, Issue S1 (2019 May)
Code
PIH16
Topic
Clinical Outcomes, Economic Evaluation
Topic Subcategory
Comparative Effectiveness or Efficacy, Cost/Cost of Illness/Resource Use Studies, Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Reproductive and Sexual Health, Surgery