Payer cost savings with endometrial ablation therapy

Area of Science:

• Gynecology
• Health Economics
• Healthcare Management

Background:

• Dysfunctional uterine bleeding (DUB) presents a substantial financial burden on US healthcare payers.
• Hysterectomy, a common treatment for DUB, incurs high hospitalization costs.

Purpose of the Study:

• To evaluate the economic advantages for payers of utilizing endometrial ablation as an alternative treatment for DUB.
• To quantify potential payer savings by comparing endometrial ablation to hysterectomy for DUB treatment.

Main Methods:

• Retrospective analysis of 24 months of healthcare claims data from premenopausal women (aged 25-50).
• Inclusion of total direct costs (payer reimbursement and patient copayment) for the entire episode of care.
• Calculation of potential payer savings based on hypothetical hysterectomy-to-ablation conversion rates (25% and 50%).

Main Results:

• Endometrial ablation can result in average per-case savings of approximately $4,300 compared to hysterectomy for DUB.
• Potential annual payer savings range from $515,000 to $1.03 million for a 1-million-member plan with 25% to 50% conversion rates.
• Uterine balloon therapy is highlighted as a technique to increase ablation utilization.

Conclusions:

• Payer organizations can reduce DUB treatment costs by favoring endometrial ablation over hysterectomy when medically appropriate.
• Despite guidelines favoring less invasive endometrial ablation, hysterectomy remains the prevalent surgical treatment for DUB.
• Payers have a financial incentive to implement policies promoting endometrial ablation for DUB.