Addressing Disparities in Care in Women’s Reproductive Health - Episode 3
Maria Lopes, MD, discusses the economic burden of UF from a payer’s perspective, explaining direct and indirect costs associated with the condition.
Maria Lopes, MD: Economic burden for uterine fibroids is significant. It’s estimated at $5.9 million to $34 billion. That’s a big spread. In reality, we don’t know. There’s a direct cost associated with uterine fibroids, and this includes surgery; outpatient imaging; therapies, GNRH agonists and now the antagonist; and obstetrical complications. Uterine fibroids can lead to significant perinatal complications and even infertility. There are also indirect costs. This affects women in the workforce: lost productivity from procedures, time off work related to procedures. You can have significant pain. Even if you’re at work, there’s presenteeism and absenteeism. There’s disability if you undergo a major surgical procedure, including a hysterectomy, and then time off for recovery. All these have significant cost, and it’s challenging to quantify exactly what the magnitude of this is. Some of it is to employers, some directly to health plans, and of course patients’ personal lives in terms of function and other resource uses, including management of pain.
Payers think about the direct cost. Drivers of resource utilization include hysterectomy. If you have a large uterus, pain, and bleeding, a definitive procedure would be hysterectomy. There are other procedures that address uterine fibroids, among them are uterine artery embolization, laparoscopic procedures, and myomectomy, which can be done laparoscopically, hysteroscopically, or through an open procedure. It’s dependent on the patient’s age and wishes. Have they completed childbearing? Is there another pathology that may be of concern? Are they surgical candidates? It’s thinking about pharmacotherapy vs surgical treatment options.
On the pharmacotherapy side, we’ve historically had oral contraceptives, which can be used for a lot of purposes. Certainly, if somebody has dysfunctional uterine bleeding, that can be used in the front line. Progestins also use this in the front line. GNRH agonists and a very exciting category, the GNRH antagonist, can address pain and bleeding. Other complications and costs are not on the gynecology side; they’re on the obstetrical side. Some women may be unable to conceive. There’s a higher risk of placental-related issues, which can lead to obstetrical complications, increased risk of cesarian section, bleeding, and preterm birth. Preterm birth for a payer brings higher costs, not just for the mother but also in NICU [newborn intensive care unit] costs for the baby if they’re severely compromised or preterm.
Patients with infertility may not be able to conceive readily. That requires infertility work-ups and IVF [in vitro fertilization], but these are all costs associated with the condition. Not all women are symptomatic, so they may not be presenting to the system with procedures. Sometimes fibroids are found incidentally through an ultrasound and followed if someone isn’t symptomatic. If they’re not conceiving as part of a work-up, they may be identified. About 25% of women are symptomatic, but this is a very common condition. It can have costs associated with patient symptoms, growth of the fibroid, location of the fibroid, and other things, including a patient’s wishes around fertility.
This transcript has been edited for clarity.