Cost Burden and Treatment Patterns Associated with Management of Heavy Menstrual Bleeding
Cost Burden and Treatment Patterns Associated with Management of Heavy Menstrual Bleeding
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DOI：
10.1089/jwh.2011.3147
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发表时间：
2012-05-01
影响因子：
3.5
通讯作者：
Duh, Mei Sheng
中科院分区：
文献类型：
--
作者：
Jensen, Jeffrey T.;Lefebvre, Patrick;Duh, Mei Sheng
目的：本研究评估了医疗资源的使用，工作效率的损失，成本和治疗模式与新诊断的特发性月经大出血（HMB）使用大型employer database.Methods：医疗和药房索赔（1998-2009年）从55自保美国公司进行了分析。年龄在18-52岁之间，有≥ 2次HMB索赔（ICD-9 626.2，627.0）且在首次索赔前连续登记≥ 6个月的女性与对照组1：1匹配。排除标准为癌症、妊娠和不孕症; HMB相关的子宫疾病;子宫内膜切除术;子宫切除术;抗凝药物;和其他已知的HMB原因。使用统计学方法比较HMB和对照队列之间的全因医疗资源使用和成本，以说明匹配的研究设计。结果：HMB和对照组（n = 29，842）在基线特征和成本方面匹配和平衡。随访期间，HMB受试者的全因资源使用显著高于对照受试者：住院发生率比（IRR）= 2.70（95%置信区间[CI] 2.62-2.79）;急诊室访视IRR = 1.35（95% CI 1.31-1.38）;门诊访视IRR = 1.29（95% CI 1.29-1.30）。HMB受试者的平均年化全因费用也高于对照组（平均差异为2，607美元，p < 0.001）。与HMB索赔相关的成本占所有原因成本差异的50%（1，313美元）。在HMB受试者中，63.2%接受手术治疗作为初始therapy.Conclusions：在这项大型配对队列研究中，特发性HMB诊断与手术干预率高、医疗资源使用和成本增加相关。
Objectives: 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.Methods: 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.Results: 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.Conclusions: 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.