Outcome and resource use associated with myomectomy

doi:10.1016/S0029-7844(01)01523-X

Obstetrics & Gynecology

Volume 98, Issue 4, October 2001, Pages 583-587

https://doi.org/10.1016/S0029-7844(01)01523-X Get rights and content

Abstract

OBJECTIVE:

To evaluate the outcomes and cost of myomectomy through retrospective claims data analysis.

METHODS:

The study was performed using a retrospective database of private insurance claims from 1995 to 1997. Records were selected for analysis based on the presence of ICD-9-CM procedure and/or CPT-4 codes associated with myomectomy. In addition, diagnosis of uterine leiomyoma and related symptoms for these patients were confirmed through ICD-9-CM diagnosis codes. Inpatient, outpatient, and physician costs were estimated. All cost data were converted into 1997 dollars.

RESULTS:

A total of 4394 women, between the ages of 14 and 70, were available for analysis. Of these, 3305 were classified by type of myomectomy procedure, and complete data were available on 820 at 1 year and 236 at 2 years. Abdominal myomectomies were the most common procedures, followed by hysteroscopic and laparoscopic myomectomies. Conversion to a more invasive procedure occurred in 5.4% of the patients. The rate of additional surgeries was 8.3% in 6 months, 10.6% in 1 year, and 16.5% in 2 years. Overall cost increased from an initial $6,737 per patient to $7,575 in 1 year and to $8,001 in 2 years.

CONCLUSION:

The repeat procedures required after the initial myomectomy add significantly to total cost and highlight the importance of assessing post-procedure health care use. This comprehensive analysis facilitates the systematic evaluation of myomectomy with current and emerging alternative treatments for uterine leiomyomas.

Section snippets

Materials and methods

The 1995, 1996, 1997 MarketScan Database developed by The MEDSTAT Group Inc. (Ann Arbor, MI) was used to perform the analysis. This database contains inpatient and outpatient claims covering over 7 million privately insured beneficiaries drawn from over 200 health plans in the US. Pharmacy data are available for a subset of these patients. The database contains no Workers’ Compensation, Medicaid, or Medicare claims. The age distribution of the database is representative of the under-65

Results

We identified 4394 women who had a myomectomy procedure during 1995, 1996, or 1997 in the MarketScan database. Follow-up assessments could not be performed on all of these women, either because we did not have the required years of data or because the patient switched health plans. After verifying patient enrollment in the health plan, 820 (18.7%) patients were available for analysis with 1-year follow-up and 236 (5.4%) patients with 2-year follow-up.

We could not identify the type of myomectomy

Discussion

Myomectomy is a commonly performed procedure for women with large leiomyomas who want to preserve their uterus. Although myomectomies are frequently performed, there is very little information on myomectomy resource use1, 3, 10, 11 and no comprehensive analysis of long-term cost. In contrast, there are numerous studies on the cost associated with performing the various types of hysterectomies.12, 13, 14, 15

Repeat procedures required after the initial myomectomy procedure adds significantly to

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Utilization of Endovascular and Surgical Treatments for Symptomatic Uterine Leiomyomas: A Population Health Perspective
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Citation Excerpt :
At 10 years’ follow-up, patient satisfaction and quality of life were high and comparable to those associated with hysterectomy (13). Previous studies have also noted that patients who undergo UAE are able to return to routine activities faster than those who undergo a more invasive surgical intervention (10,14–16). The present study also demonstrates that UAE is associated with lower charges than surgical alternatives, a finding that agrees with several other studies that have compared the cost of UAE versus hysterectomy and myomectomy (17).
To conduct a population-level analysis of surgical and endovascular interventions for symptomatic uterine leiomyomata by using administrative data from outpatient medical encounters.
By using administrative data from all outpatient hospital encounters in California (2005–2011) and Florida (2005–2014), all patients in the outpatient setting with symptomatic uterine leiomyomata were identified. Patients were categorized as undergoing hysterectomy, myomectomy, uterine artery embolization (UAE), or no intervention. Hospital stay durations and costs were recorded for each encounter.
A total of 227,489 patients with uterine leiomyomata were included, among whom 39.9% (n = 90,800) underwent an intervention, including hysterectomy (73%), myomectomy (19%), or UAE (8%). The proportion of patients undergoing hysterectomy increased over time (2005, hysterectomy, 53.2%; myomectomy, 26.9%; UAE, 18.0%; vs 2013, hysterectomy, 80.1%; myomectomy, 14.4%; UAE, 4.0%). Hysterectomy was eventually performed in 3.5% of patients who underwent UAE and 4.1% who underwent myomectomy. Mean length of stay following hysterectomy was significantly longer (0.5 d) vs myomectomy (0.2 d) and UAE (0.3 d; P < .001 for both). The mean encounter cost for UAE ($3,772) was significantly less than those for hysterectomy ($5,409; P < .001) and myomectomy ($6,318; P < .001). Of the 7,189 patients who underwent UAE during the study period, 3.5% underwent subsequent hysterectomy.
The proportion of women treated with hysterectomy in the outpatient setting has increased since 2005. As a lower-cost alternative with a low rate of conversion to hysterectomy, UAE may be an underutilized treatment option for patients with uterine leiomyomata.
Reintervention risk and quality of life outcomes after uterine-sparing interventions for fibroids: a systematic review and meta-analysis
2018, Fertility and Sterility
To compare uterine-sparing treatment options for fibroids in terms of reintervention risk and quality of life.
Systematic review and meta-analysis according to PRISMA guidelines.
Not applicable.
Women with uterine fibroids undergoing a uterine-sparing intervention.
Not applicable.
1) Reintervention risk after uterine-sparing treatment for fibroids after 12, 36, and 60 months; and 2) quality of life outcomes, based on validated questionnaires. Two separate analyses were performed for the procedures that used an abdominal approach (myomectomy, uterine artery embolization [UAE], artery ligation, high-intensity focused ultrasound [HIFU], laparoscopic radiofrequency ablation [RFA]) and for the procedures managing intracavitary fibroids (hysteroscopic approach, including hysteroscopic myomectomy and hysteroscopic RFA).
There were 85 articles included for analysis, representing 17,789 women. Stratified by treatment options, reintervention risk after 60 months was 12.2% (95% confidence interval [CI] 5.2%–21.2%) for myomectomy, 14.4% (95% CI 9.8%–19.6%) for UAE, 53.9% (95% CI 47.2%–60.4%) for HIFU, and 7% (95% CI 4.8%–9.5%) for hysteroscopy. For the other treatment options, no studies were available at 60 months. For quality of life outcomes, symptoms improved after treatment for all options. The HIFU procedure had the least favorable outcomes.
Despite the substantial heterogeneity of the study population, this meta-analysis provides valuable information on relative treatment efficacy of various uterine-sparing interventions for fibroids, which is relevant when counseling patients in daily practice. Furthermore, this study demonstrates that long-term data, particularly for the newest uterine-sparing interventions, are urgently needed.
The direct and indirect costs of uterine fibroid tumors: A systematic review of the literature between 2000 and 2013
2015, American Journal of Obstetrics and Gynecology
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Inpatient costs of UF surgery per hospital stay varied by the type of procedure and by country. In the United States, inpatient costs of UF surgery ranged from $6201–16,049 per patient per hospitalization.11,12,18,37 A huge variability was observed in the cost of surgery across different countries.
This systematic literature review was conducted to summarize the direct and indirect costs per patient that are associated with uterine fibroid tumors in international studies. A search with predefined search terms was conducted in MEDLINE and EMBASE for studies that were published from January 2000 to November 2013. The review included primary studies that were in English and that reported either direct costs (drug costs, procedure costs, and medical service costs) or indirect costs (such as productivity loss) among patients with uterine fibroid tumors. A total of 26 studies that were identified and included in the data extraction included 19 studies in the United States, 2 studies in the Netherlands, 1 study each in Germany, China, Italy, and Canada, and 1 study reported data that were collected from 3 countries: Germany, France, and England. The studies differed substantially in perspectives that were adopted for analysis, research designs, data elements that were collected, setting, populations, and outcome measurements. Among 3 studies that reported total direct costs during the year after uterine fibroid tumor diagnosis, 2 studies reported an average of $9473 and $9319 per patient, respectively; 2 studies reported the excess costs over controls to be $6076 and $5427, respectively. The indirect costs per patient ranged from $2399–15,549, and the excess indirect cost per patient over control groups ranged from $323–4824 in the year after the diagnosis. The total costs, sum of direct and indirect costs, ranged from $11,717–25,023 per patient per year, after diagnosis or surgery among patients with uterine fibroid tumors. Compared with control subjects, the additional annual cost ranged from $2200–15,952 per patient. The results of this systematic literature review highlight the substantial direct and indirect costs that are associated with uterine fibroid tumors to health care payers and society. The large number and the variety of studies identified also emphasize the growing awareness of the significant economic impact of uterine fibroid tumors. Current gaps that were identified through this review warrant further investigation to elucidate fully the economic burden of uterine fibroid tumors, including, but not limited to, burden from the patient’s perspective and the entirety of indirect costs.
Laparoscopic myomectomy: Clinical outcomes and comparative evidence
2015, Journal of Minimally Invasive Gynecology
Citation Excerpt :
Inpatient LM in that study cost $8018, compared with $7357 as an outpatient procedure. Its inpatient abdominal counterpart cost $8860 and was associated with the longest LOS (mean [SD], 2.91 [1.24] days; p = NS) [105]. Subsequent procedure rate at 1 year in that study was 7.2% in the AM group, 12.3% in the LM group, and 14.0% in the hysteroscopic group.
Laparoscopic myomectomy is a common surgical treatment for symptomatic uterine leiomyomas. Proponents of the laparoscopic approach to myomectomy propose that the advantages include shorter length of hospital stay and recovery time. Others suggest longer operative time, greater blood loss, increased risk of recurrence, risk of uterine rupture in future pregnancies, and potential dissemination of cells with use of morcellation. This review outlines techniques for performance of laparoscopic myomectomy and critically appraises the available evidence for operative data, short-term and long-term complications, and reproductive outcomes.
Often Wrong but Never in Doubt
2014, Journal of Minimally Invasive Gynecology
A comparison of the costs of laparoscopic myomectomy and open myomectomy at a teaching hospital in southern Taiwan
2013, Taiwanese Journal of Obstetrics and Gynecology
To compare the costs of traditional open myomectomy (OM) with laparoscopic myomectomy (LM).
A retrospective review was conducted of the medical records of 155 women who underwent traditional open myomectomy (OM) or laparoscopic myomectomy (LM) in a teaching hospital in Taiwan.
The total medical service expense and the patient out-of-pocket expense were significantly higher for women who received LM than for women who received OM. However, the operative time and blood loss during surgery were significantly less in women who received LM than in women who received OM.
The overall expense is higher for LM than for OM; however, the laparoscopic approach has numerous advantages for patients, including shorter operative time, less blood loss, and a more rapid recovery time. No difference existed in the rate of complications or in the recurrence of disease for the two procedures.

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¹: The authors thank Wendell Refior for his assistance with database programming and statistical analysis.

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Outcome and resource use associated with myomectomy1

Abstract

Section snippets

Materials and methods

Results

Discussion

Fertil Steril

J Am Assoc Gynecol Laparosc

J Am Assoc Gynecol Laparosc

Fertil Steril

Obstet Gynecol

Obstet Gynecol

Am J Obstet Gynecol

Outcome and resource use associated with myomectomy¹