TY - JOUR
T1 - Association between patient characteristics and treatment procedure among patients with uterine leiomyomas
AU - Borah, Bijan J.
AU - Laughlin-Tommaso, Shannon K.
AU - Myers, Evan R.
AU - Yao, Xiaoxi
AU - Stewart, Elizabeth A.
N1 - Funding Information:
Dr. Laughlin-Tommaso has received National Institutes of Health (NIH) funding (5K12HD065987-O2) and research funding, paid to the Mayo Clinic, from Truven Health Analytics and Insightec (Israel) for a focused ultrasound ablation clinical trial. She is on the data safety monitoring board for the ULTRA trial (Halt Medical, CA). Dr. Myers has been a consultant to AbbVie for consulting related to uterine leiomyoma and Merck, Inc for the human papillomavirus (HPV) vaccine. He has received research funding for outcomes of HPV screening and treatment from GSK, Inc and GenProbe/Hologic, Inc. Dr. Stewart has been a clinical trial investigator for NIH grants HD063312 and HD060503. She has received research funding, paid to the Mayo Clinic for patient care costs, from InSightec Inc. She has been a consultant to AbbVie, Astellas Pharma, Bayer Health Care, Gynesonics, and Viteava for consulting related to uterine leiomyoma, to GlaxoSmithKline for consulting related to adenomyosis, and to Welltwigs for consulting related to infertility. She has also received royalties from UpToDate and the Massachusetts Medical Society. The other authors did not report any potential conflicts of interest.
PY - 2016
Y1 - 2016
N2 - OBJECTIVE: To analyze the association between patient characteristics and the probability of undergoing any uterine-sparing procedure (endometrial ablation, myomectomy, and uterine artery embolization) compared with hysterectomy as the first uterine leiomyoma (index) procedure and the probability of undergoing a specific uterine-sparing procedure. METHODS: We conducted a retrospective analysis using a commercial insurance claims database containing more than 13 million enrollees annually. Based on the index procedure performed 2004-2009, women were classified into one of the four procedure cohorts. Eligible women were aged 25-54 years on the index date, continuously insured through 1-year baseline and 1-year follow-up, and had a baseline uterine leiomyoma diagnosis. Logistic regression was used to assess the association between patient characteristics and leiomyoma procedure. RESULTS: The study sample comprised 96,852 patients (endometrial ablation512,169; myomectomy57,039; uterine artery embolization53,835; and hysterectomy573,809). Patient characteristics associated with undergoing any uterine-sparing procedure compared with hysterectomy included health maintenance organization health plan enrollment, Northeast region residence, the highest income and education quintiles based on zip code, an age-race interaction, and baseline diagnoses including menstrual disorders, pelvic pain, anemia, endometriosis, genital prolapse, and infertility. Among those who had a uterine-sparing procedure, characteristics associated with undergoing uterine artery embolization or endometrial ablation compared with myomectomy included increasing age, being from the Midwest relative to the Northeast, and certain baseline conditions including menstrual disorder, pelvic pain, endometriosis, and infertility. CONCLUSION: Both clinical and nonclinical factors were associated with the receipt of alternatives to hysterectomy for uterine leiomyomas in commercially insured women.
AB - OBJECTIVE: To analyze the association between patient characteristics and the probability of undergoing any uterine-sparing procedure (endometrial ablation, myomectomy, and uterine artery embolization) compared with hysterectomy as the first uterine leiomyoma (index) procedure and the probability of undergoing a specific uterine-sparing procedure. METHODS: We conducted a retrospective analysis using a commercial insurance claims database containing more than 13 million enrollees annually. Based on the index procedure performed 2004-2009, women were classified into one of the four procedure cohorts. Eligible women were aged 25-54 years on the index date, continuously insured through 1-year baseline and 1-year follow-up, and had a baseline uterine leiomyoma diagnosis. Logistic regression was used to assess the association between patient characteristics and leiomyoma procedure. RESULTS: The study sample comprised 96,852 patients (endometrial ablation512,169; myomectomy57,039; uterine artery embolization53,835; and hysterectomy573,809). Patient characteristics associated with undergoing any uterine-sparing procedure compared with hysterectomy included health maintenance organization health plan enrollment, Northeast region residence, the highest income and education quintiles based on zip code, an age-race interaction, and baseline diagnoses including menstrual disorders, pelvic pain, anemia, endometriosis, genital prolapse, and infertility. Among those who had a uterine-sparing procedure, characteristics associated with undergoing uterine artery embolization or endometrial ablation compared with myomectomy included increasing age, being from the Midwest relative to the Northeast, and certain baseline conditions including menstrual disorder, pelvic pain, endometriosis, and infertility. CONCLUSION: Both clinical and nonclinical factors were associated with the receipt of alternatives to hysterectomy for uterine leiomyomas in commercially insured women.
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U2 - 10.1097/AOG.0000000000001160
DO - 10.1097/AOG.0000000000001160
M3 - Article
C2 - 26646122
AN - SCOPUS:84952715246
SN - 0029-7844
VL - 127
SP - 67
EP - 77
JO - Obstetrics and Gynecology
JF - Obstetrics and Gynecology
IS - 1
ER -