Financial and quality-of-life burden of dysfunctional uterine bleeding among women agreeing to obtain surgical treatment.
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.
Frick
Kevin D
KD
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. kfrick@jhsph.edu
Clark
Melissa A
MA
Steinwachs
Donald M
DM
Langenberg
Patricia
P
Stovall
Dale
D
Munro
Malcolm G
MG
Dickersin
Kay
K
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*