Retrospective database analysis of clinical outcomes and costs for treatment of abnormal uterine bleeding among women enrolled in US Medicaid programs

Machaon M. Bonafede, Jeffrey D. Miller, Shannon K Laughlin-Tommaso, Andrea Slukes, Nicole M. Meyer, Gregory M. Lenhart

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Women with abnormal uterine bleeding (AUB) may be treated surgically with hysterectomy or global endometrial ablation (GEA), an outpatient procedure. We compared the costs and clinical outcomes of these surgical procedures for AUB among women in Medicaid programs.

Methods: The Truven Health MarketScan® Medicaid Multi-State Database was used to identify Medicaid women aged 30-55 years with AUB who newly initiated GEA or hysterectomy (index event) during 2006-2010. Patients were required to have 12 months of continuous enrollment pre-index and post-index. Baseline characteristics were assessed in the pre-index period; health care utilization and costs (2011 USD), treatment complications, and reinterventions were assessed in the post-index period.

Results: Of 1,880 women who met the study criteria (mean age 40.7 years), 53.4% were Caucasian, 33.1% were African-American, and 2.3% were Hispanic; many (42.8%) received their Medicaid eligibility due to disability. Similar proportions received GEA (50.9%) or hysterectomy (49.1%). At baseline, both groups also had similar Deyo-Charlson Comorbidity scores (0.65), and use of antibiotics (69.4%), nonsteroidal anti-inflammatory drugs (56.3%), and oral contraceptives (5.3%). More hysterectomy patients than GEA patients had a treatment-related complication (52% versus 36%, respectively, P<0.001). Initial treatment costs were higher for hysterectomy ($11,270) than for GEA ($3,958, P<0.001); monthly gynecology-related costs in the remainder of the year were not significantly different for hysterectomy ($63) and GEA ($16, P=0.11).

Conclusion: Hysterectomy was nearly three times more costly than GEA for initial treatment of AUB, and associated with more treatment-related complications. These results may be informative in the context of new federal mandates for Medicaid expansion, which are likely to focus on cost savings through use of outpatient treatments such as GEA.

Original languageEnglish (US)
Pages (from-to)423-429
Number of pages7
JournalClinicoEconomics and Outcomes Research
Volume6
DOIs
StatePublished - Oct 8 2014

Fingerprint

Endometrial Ablation Techniques
Uterine Hemorrhage
Medicaid
Health Care Costs
Hysterectomy
Databases
Outpatients
Patient Acceptance of Health Care
Therapeutics
Costs and Cost Analysis
Data base
Costs
Cost Savings
Oral Contraceptives
Gynecology
Hispanic Americans
African Americans
Comorbidity
Anti-Inflammatory Agents
Anti-Bacterial Agents

Keywords

  • Abnormal uterine bleeding
  • Endometrial ablation
  • Hysterectomy
  • Medicaid
  • Menorrhagia

ASJC Scopus subject areas

  • Economics, Econometrics and Finance (miscellaneous)
  • Health Policy

Cite this

Retrospective database analysis of clinical outcomes and costs for treatment of abnormal uterine bleeding among women enrolled in US Medicaid programs. / Bonafede, Machaon M.; Miller, Jeffrey D.; Laughlin-Tommaso, Shannon K; Slukes, Andrea; Meyer, Nicole M.; Lenhart, Gregory M.

In: ClinicoEconomics and Outcomes Research, Vol. 6, 08.10.2014, p. 423-429.

Research output: Contribution to journalArticle

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abstract = "Background: Women with abnormal uterine bleeding (AUB) may be treated surgically with hysterectomy or global endometrial ablation (GEA), an outpatient procedure. We compared the costs and clinical outcomes of these surgical procedures for AUB among women in Medicaid programs.Methods: The Truven Health MarketScan{\circledR} Medicaid Multi-State Database was used to identify Medicaid women aged 30-55 years with AUB who newly initiated GEA or hysterectomy (index event) during 2006-2010. Patients were required to have 12 months of continuous enrollment pre-index and post-index. Baseline characteristics were assessed in the pre-index period; health care utilization and costs (2011 USD), treatment complications, and reinterventions were assessed in the post-index period.Results: Of 1,880 women who met the study criteria (mean age 40.7 years), 53.4{\%} were Caucasian, 33.1{\%} were African-American, and 2.3{\%} were Hispanic; many (42.8{\%}) received their Medicaid eligibility due to disability. Similar proportions received GEA (50.9{\%}) or hysterectomy (49.1{\%}). At baseline, both groups also had similar Deyo-Charlson Comorbidity scores (0.65), and use of antibiotics (69.4{\%}), nonsteroidal anti-inflammatory drugs (56.3{\%}), and oral contraceptives (5.3{\%}). More hysterectomy patients than GEA patients had a treatment-related complication (52{\%} versus 36{\%}, respectively, P<0.001). Initial treatment costs were higher for hysterectomy ($11,270) than for GEA ($3,958, P<0.001); monthly gynecology-related costs in the remainder of the year were not significantly different for hysterectomy ($63) and GEA ($16, P=0.11).Conclusion: Hysterectomy was nearly three times more costly than GEA for initial treatment of AUB, and associated with more treatment-related complications. These results may be informative in the context of new federal mandates for Medicaid expansion, which are likely to focus on cost savings through use of outpatient treatments such as GEA.",
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