UTERINE FIBROID TREATMENT PATTERNS IN
THE THREE YEARS FOLLOWING DIAGNOSIS
Machaon M. Bonafede, PhD, MPH
Director, Outcomes Research
Truven Health Analytics Inc.
Cambridge, Massachusetts USA
(603) 580-5587
machaon.bonafede@truvenhealth.com
Machaon M. Bonafede, PhD, MPH1; Ellen Riehle, MPH1; Scott Pohlman, MS2; Kathleen A. Troeger, MPH2
Truven Health Analytics; 2Hologic, Inc.
1
BACKGROUND
ANALYSIS RESULTS (CONT’D)
Uterine fibroids (also known as leiomyomas or myomas) are the most common benign
tumors in women.
•
Although often asymptomatic, some uterine fibroids can cause abnormal uterine bleeding
and pelvic pain.1,2
•
Research suggests that over 60% of women will develop uterine fibroids in their lifetime,
with incidence increasing with age.3,4
•
Treatments options include symptom management, removal of fibroids, and hysterectomy.
•
Uterine fibroids are the leading indication for hysterectomies in the US.4
•
There is evidence supporting the use of minimally-invasive treatments to remove
fibroids with lower costs, complication rates and higher quality-of-life outcomes
compared to hysterectomies.2,5-7
Figure 2. Pharmacological Treatments
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OBJECTIVE
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To describe treatment patterns and diagnostic pathways for women with uterine
fibroids in the three years following a new diagnosis.
METHODS
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Data Sources
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Truven Health MarketScan® Commercial Database
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— Contains medical and prescription data on approximately 35 million US employees
annually and their dependents with employer-sponsored private health insurance.
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MarketScan Medicare Supplemental Database
— Contains medical and prescription data for approximately 3 million retirees annually
with Medicare supplemental insurance paid for by employers.
— Includes the Medicare-covered portion of payment (coordination of benefits amount,
or COB) and the employer-paid portion.
Figure 3. Non-Pharmacological Treatments
Patient Selection
The MarketScan Commercial and Medicare Supplemental Databases were used to
identify women with a new diagnosis of uterine fibroids (index event, ICD-9-CM code 218.9)
from 2004 to 2013.
•
Women were required to have 12 months pre- and 12, 24, or 36 months of post-index
continuous enrollment (the 12-month period prior to the index date was designated the
baseline period)
•
Patients with any diagnosis of uterine fibroids or polyps (ICD-9-CM code 621.0) in the
baseline period were excluded; thus, the index event diagnosis represented a new
diagnosis for patients included in the analysis.
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Treatment Pattern Description
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The use of diagnostic procedures, pharmacologic treatments, and non-pharmacologic
treatments, as identified by administrative claims, were measured in the 12-month
baseline period and the following 12, 24, and 36 months after the initial uterine fibroid
diagnosis.
•
Patients could use multiple medications or procedures throughout the study period.
ANALYSIS RESULTS
Demographics
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A total of 359,672 patients with 12 months of follow-up met the selection criteria.
•
Mean age at diagnosis was 46.1 years (SD=9.3).
— Samples with longer follow-up: 24 months, N = 244,827; 36 months, N = 164,645.
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— Age groups: 22.8% were <40; 45.8% were 40–49; 31.3% were ≥50.
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Imaging Procedures
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The most common imaging procedures during the three years after uterine fibroid
diagnosis were transvaginal ultrasounds, abdominal/pelvic ultrasounds, computerized
tomography, and pelvic magnetic resonance imaging (Figure 1).
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Hysterosonography, hysterosalpingography, and hysteroscopy, were each performed in
less than 5% of women in all follow-up timeframes.
Pharmacological Treatment
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The most commonly prescribed pharmacological treatment was prescription NSAIDs;
the proportion of women receiving this treatment increased during the three years of
follow-up, so a direct relationship between NSAIDs for fibroid-related complications
versus other possibilities cannot be determined. Hormonal contraceptives (including
intrauterine devices) and gonadotropin-releasing hormone agents were the next most
common prescription therapy, and utilization appeared to remain steady in the 36
months following the uterine fibroid diagnosis (Figure 2).
DISCUSSION
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Many minimally invasive procedures are available for the treatment of uterine fibroids,
yet approximately one in three women diagnosed with uterine fibroids will undergo a
hysterectomy within the first year of a uterine fibroid diagnosis.
•
Hysterectomy was the most commonly performed procedure in the years following
uterine fibroid diagnosis, increasing from 29.3% in the first year to 35.5% after three
years (Figure 3).
Hysterectomy is less commonly performed among women diagnosed before the age
of 40 compared to women past peak childbearing years, although the rate is still
substantial considering that fertility-sparing treatments are available.
•
— The proportion of women undergoing hysterectomy within one year of diagnosis in
each age group was: <40years old, 21.9%; 40–49 years old, 35.7%; and ≥50 years
old, 25.4%.
This treatment patterns study shows that minimally invasive procedures were not
commonly used in this patient population (<7% for a single modality within three years
of initial diagnosis).
•
Increasing the utilization of minimally invasive procedures may reduce the clinical and
economic burden of treating uterine fibroids.
Non-Pharmacological Treatments
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— The proportion of hysterectomies performed in conjunction with removal of
leiomyoma (CPT code 58572 or 58290) was 1.9%.
— Approximately 1% of women undergoing hysterectomy had a prior myomectomy
procedure (from the beginning of the baseline period to hysterectomy date).
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Minimally invasive procedures were utilized at much lower rates than hysterectomy.
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Within three years of diagnosis, 6.4% of women underwent endometrial ablation, 5.6%
underwent curettage procedures, and 5.4% underwent myomectomy.
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Overall, hysteroscopic myomectomy was the most common myomectomy procedure
(2.5% in three years), followed by abdominal (2.1%) and laparoscopic/robotic (1.0%).
Figure 1. Imaging Procedures
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LIMITATIONS
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Diagnostic and procedural coding are limited in their ability to capture disease severity
as it relates to the necessity of hysterectomy versus a minimally invasive approach.
— The data sources used do not contain information on potential comorbidities or
fibroid location, volume, or severity. These factors would impact the necessity of
hysterectomy. Future research should explore this further to identify the potential
number of avoidable hysterectomy cases.
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This analysis was conducted among women with commercial health insurance in the US
and may not apply to other patient populations, including patients with Medicaid, the
uninsured, or women with full Medicare.
REFERENCES
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Ultrasound,transvaginal
Ultrasound,abdominal/pelvic
Computerizedtomography(pelvis)
Magneticresonanceimaging(pelvis)
MISC-03349-001 Hologic Inc.
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Research. Clinical Obstetrics & Gynaecology Aug 2008; 22(4): 571–588.
2. Hirst A, Dutton S, Wu O, et al. A multi-centre retrospective cohort study comparing the
efficacy, safety and cost-effectiveness of hysterectomy and uterine artery embolisation
for the treatment of symptomatic uterine fibroids. The HOPEFUL study. Health
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artery embolization for symptomatic fibroids: long-term changes in disease-specific
symptoms and quality of life. Human Reproduction Aug 2011; 26(8): 2036–2042.
7. Fennessy FM, Kong CY, Tempany CM, Swan JS. Quality-of-life assessment of fibroid
treatment options and outcomes. Radiology Jun 2011; 259(3): 785–792.
This study was funded by Hologic, Inc