ArticleFinancial and Quality-of-Life Burden of Dysfunctional Uterine Bleeding Among Women Agreeing To Obtain Surgical Treatment
Section snippets
Introduction and Background
Abnormal uterine bleeding (AUB) has been estimated to occur in 9%–14% of healthy premenopausal women (Rosenfeld, 1997) and often requires medical or surgical intervention. Dysfunctional uterine bleeding (DUB) is diagnosed when AUB occurs unrelated to demonstrable uterine pathology, pharmacologic agents, intrauterine conception, or systemic disorders of hemostasis. DUB manifests with 1 or all of the following features: abnormal timing, volume, or duration of flow (Livingstone & Fraser, 2002).
Methods
The Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding (STOP-DUB) was a randomized trial comparing the effectiveness of hysterectomy versus endometrial ablation in women with DUB who had not responded to medical management. The design and methods have been discussed in detail elsewhere (Dickersin et al., 2003). Economic evaluation data collection and analyses were planned for in the initial study design. The following provides a brief summary.
The study was approved by the
Results
At the time of enrollment, the majority of the randomized women were between the ages of 36 and 45, and 78% were white (Table 1). The median household income was between $15,001 and $25,000. The majority of women had not attended college; over half were married. Almost all the women (98%) were seeking treatment because of excessive bleeding, with 78% of women reporting seeking care for pelvic pain and 72% for fatigue.
Table 2 shows the elements of the financial and quality-of-life burden of DUB
Conclusions and Discussion
The financial and quality-of-life burden of DUB for women is substantial. The estimated annual direct costs (pharmaceuticals and excess pads and tampons) were $333, or >1% of the median annual household pretax income for randomized women. The estimated indirect costs are considerably larger than the estimated direct costs. The sizeable financial burden for women and their families in the STOP-DUB trial, even when out-of-pocket costs for physician visits are not included, likely influenced the
Kevin D. Frick, PhD, is an Associate Professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. He is an economic evaluation expert whose work focuses on nursing, ophthalmology, and family health issues.
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2022, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :Thus, we anticipated that an effect of a greater amplitude on the improvement of both outcomes could be observed with less experienced clinicians, such as generalist gynaecologists and family doctors. Bearing in mind that AUB puts a heavy economic burden on society, with an estimated total cost of $13 billion annually in the United States,3,27,28 maximum effort should be put into optimizing AUB assessment. Undoubtedly, our standardized questionnaire could be useful to do so, particularly for the initial assessment of AUB in the setting of first-line health care.
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2020, Thrombosis UpdateCitation Excerpt :Available evidence suggests that up to half of women afflicted by AUB do not seek medical advice for their symptoms, even if they have access to healthcare services [16], the reasons for which are poorly explored in the literature. Although data suggest that severe and life-threatening anticoagulant-associated AUB is rare, its detrimental psychosocial effects cannot be underestimated, with manifestations ranging from modest to severe disruption of work productivity and quality of life [17]. Cohort studies suggest that AUB occurrence may vary between anticoagulation regimens (although study methods and reported AUB rates are heterogenous) [18–21].
Kevin D. Frick, PhD, is an Associate Professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. He is an economic evaluation expert whose work focuses on nursing, ophthalmology, and family health issues.
Melissa A. Clark, PhD, is an Associate Professor in the Departments of Community Health and Obstetrics and Gynecology in the Warren Alpert School of Medicine and Program in Public Health at Brown University. She is a Survey Methodologist whose work focuses on women's health and underserved populations.
Donald M. Steinwachs, PhD, is a Professor in the Department of Health Policy and Management and Director of the Health Services Research and Development Center at the Johns Hopkins University Bloomberg School of Public Health. He is trained in operations research and his work focuses on improving medical effectiveness and patient outcomes, use of management information systems to monitor quality of care, examining the impact of financing alternatives on cost and quality, and health system performance.
Patricia Langenberg, PhD, is a statistician involved many funded women's health studies. She chairs the Women's Health Research Group at the University of Maryland at Baltimore (UMAB), an inter-disciplinary body housed in Epidemiology but with membership across the UMAB campus. She is also Principal Investigator of an NIH-funded grant ‘Building indisciplinary research careers in Women's Health (BIRCWH)’ that funds faculty members at the beginning of their careers working in areas of women's health research.
Dale W. Stovall, MD, is Professor and Director of the Division of Reproductive Endocrinology and Infertility in the Department of Obstetrics and Gynecology at the University of Virginia. He is a clinician and clinical investigator whose areas of interest include treatments for dysfunctional uterine bleeding, polycystic ovary disease, assisted reproduction, and endoscopic surgery.
Malcolm G. Munro, MD, is a Professor in the Department of Obstetrics and Gynecology of the David Geffen School of Medicine at UCLA, and the Director of Gynecologic Services at Kaiser-Permanente Los Angeles Medical Center. His clinical and research activity focuses on diagnosis, evaluation and minimally invasive treatment of women with abnormal uterine bleeding.
Kay Dickersin, PhD, is Professor of Epidemiology at Johns Hopkins Bloomberg School of Public Health and the Director of the Center for Clinical Trials. She also directs the US Cochrane Center. Dr. Dickersin's major research contributions have been in clinical trials, publication bias, trials registers, systematic reviews, and evidence-based healthcare.
Funded by Grant #5U01 HS09506 from the Agency for Healthcare Research and Quality to the University of Maryland (1996 to 1998) and Brown Medical School (1998–2001), and grant #5U01 HS09506 and #5HS09506a to Brown University (2001–2005).
Clinicaltrials.gov identifier: NCT00114088.