Payer cost savings with endometrial ablation therapy

Context: Dysfunctional uterine bleeding (DUB) is a significant cost burden for payers in the US healthcare system because hysterectomy, the common cur ative treatment, is associated with high hospitalization costs. Objective: To determine the potential economic benefit to payers of endomet rial ablation as an alternate treatment for the benign DUE disorder. Study Design: A retrospective analysis of healthcare claims including the t otal direct costs to the payer (reimbursement) and patient (copayment), The study was designed to capture all DUE-related claims costs for the entire episode of care from initial diagnosis through follow-up care for 12 months postprocedure. Patients and Methods: Twenty-four months of claims data from premenopausal women aged 25 to 50 years enrolled in a large managed care organization wer e screened based on relevant diagnostic and procedural codes. Incidence and costs of hysterectomy and ablation were determined, and potential payer sa vings were calculated based on hypothetical hysterectomy-to-ablation conver sion rates of 25% to 50%. Results: By performing ablation in lieu of hysterectomy for DUE, an average per-case savings of approximately $4,300 is possible. Potential annual pay er savings are approximately $515,000 and $1.03 million for a 1-million-mem ber plan, based on the 25% and 50% conversion rates, respectively. The rece ntly approved uterine balloon therapy ablation technique could be instrumen tal in overcoming current barriers to wider utilization of ablation surgery . Conclusion: If ablation is used in lieu of hysterectomy when medically appr opriate, a payer organization could reduce the cost of treating patients wi th DUE who are not responsive to drug therapy or dilation and curettage alo ne. Our data suggest that hysterectomy is the most common surgical therapy for this disorder, even though the less invasive endometrial ablation appro ach is more consistent with accepted DUE treatment guidelines. Payers there fore have an economic incentive to adopt guidelines and reimbursement polic ies that promote ablation therapy for DUB.