Department of Obstetrics & Gynecology, Oregon Health and Science University, Women's Health Research Unit, Portland, Oregon 97239, USA.
J Womens Health (Larchmt). 2012 May;21(5):539-47. doi: 10.1089/jwh.2011.3147. Epub 2012 Feb 23.
This study evaluated the healthcare resource use, work productivity loss, costs, and treatment patterns associated with newly diagnosed idiopathic heavy menstrual bleeding (HMB) using a large employer database.
Medical and pharmacy claims (1998-2009) from 55 self-insured U.S. companies were analyzed. Women aged 18-52 years with ≥2 HMB claims (ICD-9 626.2, 627.0) and continuously enrolled for ≥6 months before the first claim were matched 1:1 with controls. Exclusion criteria were cancer, pregnancy, and infertility; HMB-related uterine conditions; endometrial ablation; hysterectomy; anticoagulant medications; and other known HMB causes. All-cause healthcare resource use and costs were compared between the HMB and control cohorts using statistical methods accounting for matched study design. Treatment patterns were examined for HMB subjects.
HMB and control cohorts (n=29,842 in both) were matched and balanced in baseline characteristics and costs. During follow-up, HMB subjects had significantly higher all-cause resource use than did control subjects: hospitalization incidence rate ratio (IRR)=2.70 (95% confidence interval [CI] 2.62-2.79); emergency room visits IRR=1.35 (95% CI 1.31-1.38); outpatient visits IRR=1.29 (95% CI 1.29-1.30). Average annualized all-cause costs were also higher for HMB subjects than controls (mean difference $2,607, p<0.001). Costs associated with HMB claims represented 50% ($1,313) of the all-cause cost difference. Of HMB subjects, 63.2% underwent surgical treatment as initial therapy.
In this large matched-cohort study, an idiopathic diagnosis of HMB was associated with high rates of surgical intervention and increased healthcare resource use and costs.
本研究使用大型雇主数据库评估了新诊断为特发性月经过多（HMB）的患者的医疗资源利用、工作生产力损失、成本和治疗模式。
分析了来自 55 家美国自保险公司的 1998 年至 2009 年的医疗和药房索赔数据。年龄在 18-52 岁之间、至少有 2 次 HMB 索赔（ICD-9 626.2、627.0）且在首次索赔前连续登记至少 6 个月的女性与对照组按 1:1 匹配。排除标准为癌症、妊娠和不孕；与 HMB 相关的子宫状况；子宫内膜消融术；子宫切除术；抗凝药物；以及其他已知的 HMB 病因。使用统计方法比较 HMB 队列和对照组的全因医疗资源利用和成本，该方法考虑了匹配的研究设计。对 HMB 患者的治疗模式进行了检查。
HMB 和对照组（各 29842 例）在基线特征和成本方面相匹配且均衡。在随访期间，HMB 患者的全因资源利用明显高于对照组：住院发生率比（IRR）=2.70（95%置信区间[CI] 2.62-2.79）；急诊就诊 IRR=1.35（95% CI 1.31-1.38）；门诊就诊 IRR=1.29（95% CI 1.29-1.30）。HMB 患者的平均年化全因成本也高于对照组（平均差异$2607，p<0.001）。与 HMB 索赔相关的成本占全因成本差异的 50%（$1313）。在 HMB 患者中，63.2%的患者接受了手术治疗作为初始治疗。
在这项大型匹配队列研究中，特发性 HMB 诊断与高手术干预率以及更高的医疗资源利用和成本相关。
