Borah Bijan J, Carls Ginger S, Moore Brian J, Gibson Teresa B, Moriarty James P, Stewart Elizabeth A
Division of Health Care Policy and Research & College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Truven Health Analytics, 777 E. Eisenhower Parkway, Ann Arbor, MI 48108, USA.
J Ther Ultrasound. 2014 Mar 31;2:7. doi: 10.1186/2050-5736-2-7. eCollection 2014.
To compare one-year all-cause and uterine fibroid (UF)-related direct costs in patients treated with one of the following three uterine-sparing procedures: magnetic resonance-guided focused ultrasound (MRgFUS), uterine artery embolization (UAE) and myomectomy.
This retrospective observational cohort study used healthcare claims for several million individuals with healthcare coverage from employers in the MarketScan Database for the period 2003-2010. UF patients aged 25-54 on their first UF procedure (index) date with 366-day baseline experience, 366-day follow-up period, continuous health plan enrollment during baseline and follow-up, and absence of any baseline UF procedures were included in the final sample. Cost outcomes were measured by allowed charges (sum of insurer-paid and patient-paid amounts). UF-related cost was defined as difference in mean cost between study cohorts and propensity-score-matched control cohorts without UF. Multivariate adjustment of cost outcomes was conducted using generalized linear models.
The study sample comprised 14,426 patients (MRgFUS = 14; UAE = 4,092; myomectomy = 10,320) with a higher percent of older patients in MRgFUS cohort (71% vs. 50% vs. 12% in age-group 45-54, P < 0.001). Adjusted all-cause mean cost was lowest for MRgFUS ($19,763; 95% CI: $10,425-$38,694) followed by myomectomy ($20,407; 95% CI: $19,483-$21,381) and UAE ($25,019; 95% CI: $23,738-$26,376) but without statistical significance. Adjusted UF-related costs were also not significantly different between the three procedures.
Adjusted all-cause and UF-related costs at one year were not significantly different between patients undergoing MRgFUS, myomectomy and UAE.
比较接受以下三种保留子宫手术之一的患者的一年全因成本和子宫肌瘤（UF）相关直接成本：磁共振引导聚焦超声（MRgFUS）、子宫动脉栓塞术（UAE）和肌瘤切除术。
这项回顾性观察性队列研究使用了2003 - 2010年期间MarketScan数据库中数百万有雇主医保覆盖人群的医疗理赔数据。最终样本纳入了年龄在25 - 54岁、首次进行UF手术（索引）日期、有366天基线经历、366天随访期、在基线和随访期间持续参加健康计划且无任何基线UF手术的UF患者。成本结果通过允许费用（保险公司支付和患者支付金额之和）来衡量。UF相关成本定义为研究队列与无UF的倾向评分匹配对照队列之间的平均成本差异。使用广义线性模型对成本结果进行多变量调整。
研究样本包括14426例患者（MRgFUS组 = 14例；UAE组 = 4092例；肌瘤切除术组 = 10320例），MRgFUS队列中老年患者比例更高（45 - 54岁年龄组中分别为71%、50%和12%，P < 0.001）。调整后的全因平均成本MRgFUS最低（19763美元；95%可信区间：10425 - 38694美元），其次是肌瘤切除术（20407美元；95%可信区间：19483 - 21381美元）和UAE（25019美元；95%可信区间：23738 - 26376美元），但无统计学意义。三种手术之间调整后的UF相关成本也无显著差异。
接受MRgFUS、肌瘤切除术和UAE的患者在一年时调整后的全因成本和UF相关成本无显著差异。
