OBJECTIVES: The study aimed to assess differences in the current medical care situation of women with abnormal uterine bleeding (AUB) in Germany (D), Austria (A) and Switzerland (CH) (DACH). The study focused on describing the availability of and access to surgical therapy options of the respective health care systems, in order to compare the countries regarding structural data and evidence requirements in women’s health care.

METHODS: Data were obtained through official databases, medical associations and governmental institutions (G-BA, AGES, Swissmedic, etc.) of the respective countries. Additionally, internet searches were conducted to identify recent country-specific information. Key figures used for analyzing differences between the DACH countries were:

• Structural data: Variables describing the health care situation regarding the indication AUB, e.g. prevalence of AUB, doctors/1000 women, hospitals/1000 women, financing framework, setting of care/procedures, number of procedures/1000 women.
• Requirements: Clinical and health economic evidence, e.g. requirement standard rating based on evidence level according to the GRADE scheme (1= high; 2=medium; >2= low).

Searches were performed in 2017. For every country, the latest available figures were used.

RESULTS: The hysterectomy rates per 1000 women differ between the three countries, with Germany having the highest rate. Differences were also found in ablation techniques, these procedures are most frequently done in Switzerland, which is explained by the higher fee of material expenses (Sachkostenpauschale). Clinical and HEOR evidence requirements vary, depending on the setting. Compared to the other two countries, the inpatient access requirements are lowest in Germany.

CONCLUSIONS: The difference in procedure rates is assumed to be influenced by the different financial frameworks of reimbursement in the countries. Cross-border standards for the treatment of AUB should be implemented to ensure equal access to uterus-preserving therapies. Furthermore, real world evidence is needed to explain the differences especially in hysterectomy rates between the three countries.