Elsevier

Women's Health Issues

Volume 19, Issue 1, January–February 2009, Pages 70-78
Women's Health Issues

Article
Financial and Quality-of-Life Burden of Dysfunctional Uterine Bleeding Among Women Agreeing To Obtain Surgical Treatment

https://doi.org/10.1016/j.whi.2008.07.002Get rights and content

Purpose

In this study, we sought to 1) describe elements of the financial and quality-of-life burden of dysfunctional uterine bleeding (DUB) from the perspective of women who agreed to obtain surgical treatment; 2) explore associations between DUB symptom characteristics and the financial and quality-of-life burden; 3) estimate the annual dollar value of the financial burden; and 4) estimate the most that could be spent on surgery to eliminate DUB symptoms for which medical treatment has been unsuccessful that would result in a $50,000/quality-adjusted life-year incremental cost-effectiveness ratio.

Methods

We collected baseline data on DUB symptoms and aspects of the financial and quality-of-life burden for 237 women agreeing to surgery for DUB in a randomized trial comparing hysterectomy with endometrial ablation. Measures included out-of-pocket pharmaceutical expenditures, excess expenditures on pads or tampons, the value of time missed from paid work and home management activities, and health utility. We used χ2 and t tests to assess the statistical significance of associations between DUB characteristics and the financial and quality-of-life burden. The annual financial burden was estimated.

Results

Pelvic pain and cramps were associated with activity limitations and tiredness was associated with a lower health utility. Excess pharmaceutical and pad and tampon costs were $333 per patient per year (95% confidence interval [CI], $263–$403). Excess paid work and home management loss costs were $2,291 per patient per year (95% CI, $1847–$2752). Effective surgical treatment costing $40,000 would be cost-effective compared with unsuccessful medical treatment.

Conclusion

The financial and quality-of-life effects of DUB represent a substantial burden.

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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    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.

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