Insurance-Based Differences in Treatment Patterns for Uterine Fibroids

Area of Science:

• Reproductive Medicine
• Health Services Research
• Medical Economics

Background:

• Uterine fibroids affect many women of reproductive age.
• Treatment options include hysterectomy, myomectomy, and uterine artery embolization (UAE).
• Insurance status and reimbursement rates may influence treatment choices.

Purpose of the Study:

• To investigate the association between insurance type (Medicaid vs. commercial) and reimbursement rates with UAE utilization for uterine fibroid treatment.
• To examine how insurance influences the choice between UAE and surgical interventions like hysterectomy or myomectomy.
• To assess insurance-related disparities in the adoption of minimally invasive surgical techniques.

Main Methods:

• Retrospective analysis of women aged 30-59 with uterine fibroids (Oct 2015-Sep 2023).
• Utilized the Inovalon Insights dataset, comparing patients with Medicaid and commercial insurance.
• Employed logistic regression to analyze differences in procedure selection and approach, controlling for patient and geographic factors.

Main Results:

• Medicaid insurance was linked to a 38% increase in the odds of undergoing UAE compared to commercial insurance.
• Higher state-level Medicaid reimbursement for hysterectomy correlated with decreased UAE utilization.
• Medicaid patients were 20% less likely to undergo hysterectomy or myomectomy laparoscopically.

Conclusions:

• Insurance status appears to influence treatment decisions for uterine fibroids, favoring less invasive UAE for Medicaid patients.
• Medicaid patients undergoing traditional surgery face disparities in minimally invasive approaches.
• Findings suggest insurance reimbursement and coverage influence physician referrals and patient treatment pathways.