title: Financial and quality-of-life burden of dysfunctional uterine bleeding among women agreeing to obtain surgical treatment.
abstract: OBJECTIVE
  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 chi2 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.
  
  
  CONCLUSIONS
  The financial and quality-of-life effects of DUB represent a substantial burden.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. kfrick@jhsph.edu
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Clark
authors.forename: Donald M
authors.initials: DM
authors.lastname: Steinwachs
authors.forename: Patricia
authors.initials: P
authors.lastname: Langenberg
authors.forename: Dale
authors.initials: D
authors.lastname: Stovall
authors.forename: Malcolm G
authors.initials: MG
authors.lastname: Munro
authors.forename: Kay
authors.initials: K
authors.lastname: Dickersin
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D055356:Endometrial Ablation Techniques / Q000191:economics*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics*; D008796:Metrorrhagia / Q000191:economics* / Q000601:surgery*; D008875:Middle Aged; D016017:Odds Ratio; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D016387:Women's Health / Q000191:economics*