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.