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This study analyzed 295,148 insurance claims from New York between 2001 and 2005 to evaluate how patient clinical factors influence the utilization of hysterectomy versus alternative procedures such as uterine artery embolization or ablative therapy. The results indicated that patients undergoing hysterectomies were significantly older than those receiving alternatives, with fibroids being the primary diagnosis for hysterectomy cases while abnormal bleeding dominated claims for alternative treatments. The authors concluded that specific diagnostic groups and age demographics play a critical role in determining whether patients receive definitive surgical management or less invasive interventions. Relevance to endometriosis: listed as one indication within the inflammation/mass/pain/endometriosis diagnostic category, which accounted for 32% of all claims and 14.7% of hysterectomy diagnoses in this analysis.
Abstract
Alternatives to hysterectomy such as medical treatment, uterine artery embolization (UAE), and ablative therapy have become available and widely used in the last 10 years. It is unclear if these alternatives are replacing hysterectomy or delaying it. To determine the effect of patient clinical factors on the utilization of hysterectomy and alternatives of hysterectomy, the investigators examined all claims relating to a hysterectomy procedure or a hysterectomy-associated diagnosis in the database of a large insurance provider for 48 consecutive months from 2001 to 2005. A total of 295,148 claim lines were abstracted and analyzed by CPT and diagnostic grouping codes. Of the 7049 procedures represented in the claim lines, 1972 were hysterectomies and 5077 were hysterectomy alternatives. The mean age of patients filing claims was 39.1 years. Patients submitting claims for a hysterectomy were older than those having an alternative procedure (mean age, 49.7 v 46.0 years, P < .0001). The diagnostic group associated with the majority of all claims was abnormal bleeding (33%); the inflammation/mass/pain/endometriosis group accounted for 32%. The most common diagnostic groups associated with a hysterectomy were fibroids (39.4%), the inflammation/mass/pain/endometriosis category (14.7%), and cancer (13.0%). Bleeding represented the majority of claims for hysterectomy alternatives accounting for 60.5%; it accounted for only for 12.8% of the hysterectomies. The investigators conclude from these findings that patient factors of age and diagnostic group influence the utilization and timing of hysterectomy alternatives. These findings support the view that use of alternative procedures delay or reduce the need for hysterectomy.
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Patient Clinical Factors Influencing Use of Hysterectomy in New York, 2001–2005
- Herbert Gretz
- William H. Bradley
- Konstantin Zakashansky
- Farr Nezhat
- Jamal Rahaman
- Linus Chuang
- Deborah Loeb Bohren
- Kenneth Kreiger
- Elizabeth Rubin
- Alan Sokolow
Alternatives to hysterectomy such as medical treatment, uterine artery embolization (UAE), and ablative therapy have become available and widely used in the last 10 years. It is unclear if these alternatives are replacing hysterectomy or delaying it. To determine the effect of patient clinical factors on the utilization of hysterectomy and alternatives of hysterectomy, the investigators examined all claims relating to a hysterectomy procedure or a hysterectomy-associated diagnosis in the database of a large insurance provider for 48 consecutive months from 2001 to 2005. A total of 295,148 claim lines were abstracted and analyzed by CPT and diagnostic grouping codes.
Of the 7049 procedures represented in the claim lines, 1972 were hysterectomies and 5077 were hysterectomy alternatives. The mean age of patients filing claims was 39.1 years. Patients submitting claims for a hysterectomy were older than those having an alternative procedure (mean age, 49.7 v 46.0 years, P < .0001). The diagnostic group associated with the majority of all claims was abnormal bleeding (33%); the inflammation/mass/pain/endometriosis group accounted for 32%. The most common diagnostic groups associated with a hysterectomy were fibroids (39.4%), the inflammation/mass/pain/endometriosis category (14.7%), and cancer (13.0%). Bleeding represented the majority of claims for hysterectomy alternatives accounting for 60.5%; it accounted for only for 12.8% of the hysterectomies.
The investigators conclude from these findings that patient factors of age and diagnostic group influence the utilization and timing of hysterectomy alternatives. These findings support the view that use of alternative procedures delay or reduce the need for hysterectomy.
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