London R, Holzman M, Rubin D, Moffitt B
CNA Health Partners, Chicago, IL, USA.
Am J Manag Care. 1999 Jul;5(7):889-97.
Dysfunctional uterine bleeding (DUB) is a significant cost burden for payers in the US healthcare system because hysterectomy, the common curative treatment, is associated with high hospitalization costs.
To determine the potential economic benefit to payers of endometrial ablation as an alternate treatment for the benign DUB disorder.
A retrospective analysis of healthcare claims including the total direct costs to the payer (reimbursement) and patient (copayment). The study was designed to capture all DUB-related claims costs for the entire episode of care from initial diagnosis through follow-up care for 12 months postprocedure.
Twenty-four months of claims data from premenopausal women aged 25 to 50 years enrolled in a large managed care organization were screened based on relevant diagnostic and procedural codes. Incidence and costs of hysterectomy and ablation were determined, and potential payer savings were calculated based on hypothetical hysterectomy-to-ablation conversion rates of 25% to 50%.
By performing ablation in lieu of hysterectomy for DUB, an average per-case savings of approximately $4,300 is possible. Potential annual payer savings are approximately $515,000 and $1.03 million for a 1-million-member plan, based on the 25% and 50% conversion rates, respectively. The recently approved uterine balloon therapy ablation technique could be instrumental in overcoming current barriers to wider utilization of ablation surgery.
If ablation is used in lieu of hysterectomy when medically appropriate, a payer organization could reduce the cost of treating patients with DUB who are not responsive to drug therapy or dilation and curettage alone. Our data suggest that hysterectomy is the most common surgical therapy for this disorder, even though the less invasive endometrial ablation approach is more consistent with accepted DUB treatment guidelines. Payers therefore have an economic incentive to adopt guidelines and reimbursement policies that promote ablation therapy for DUB.
功能失调性子宫出血（DUB）给美国医疗保健系统的支付方带来了巨大的成本负担，因为子宫切除术作为常见的根治性治疗方法，其住院成本高昂。
确定子宫内膜切除术作为良性DUB疾病替代治疗方法给支付方带来的潜在经济效益。
对医疗保健索赔进行回顾性分析，包括支付方（报销）和患者（自付费用）的总直接成本。该研究旨在获取从初始诊断到术后12个月随访护理整个治疗过程中所有与DUB相关的索赔成本。
根据相关诊断和程序代码，对在一家大型管理式医疗组织登记的25至50岁绝经前女性的24个月索赔数据进行筛选。确定子宫切除术和子宫内膜切除术的发生率及成本，并根据25%至50%的假设子宫切除术至子宫内膜切除术转化率计算支付方的潜在节省费用。
通过对DUB患者进行子宫内膜切除术而非子宫切除术，每例平均可节省约4300美元。对于一个拥有100万会员的计划，基于25%和50%的转化率，支付方每年的潜在节省费用分别约为51.5万美元和103万美元。最近批准的子宫球囊治疗消融技术可能有助于克服目前阻碍消融手术更广泛应用的障碍。
如果在医学上合适时使用子宫内膜切除术替代子宫切除术，支付方组织可以降低治疗对药物治疗或单纯刮宫无反应的DUB患者的成本。我们的数据表明，子宫切除术是该疾病最常见的手术治疗方法，尽管侵入性较小的子宫内膜切除术方法更符合公认的DUB治疗指南。因此，支付方有经济动机采用促进DUB消融治疗的指南和报销政策。
