title: Cost burden and treatment patterns associated with management of heavy menstrual bleeding.
abstract: OBJECTIVE
  This study evaluated the healthcare resource use, work productivity loss, costs, and treatment patterns associated with newly diagnosed idiopathic heavy menstrual bleeding (HMB) using a large employer database.
  
  
  METHODS
  Medical and pharmacy claims (1998-2009) from 55 self-insured U.S. companies were analyzed. Women aged 18-52 years with ≥2 HMB claims (ICD-9 626.2, 627.0) and continuously enrolled for ≥6 months before the first claim were matched 1:1 with controls. Exclusion criteria were cancer, pregnancy, and infertility; HMB-related uterine conditions; endometrial ablation; hysterectomy; anticoagulant medications; and other known HMB causes. All-cause healthcare resource use and costs were compared between the HMB and control cohorts using statistical methods accounting for matched study design. Treatment patterns were examined for HMB subjects.
  
  
  RESULTS
  HMB and control cohorts (n=29,842 in both) were matched and balanced in baseline characteristics and costs. During follow-up, HMB subjects had significantly higher all-cause resource use than did control subjects: hospitalization incidence rate ratio (IRR)=2.70 (95% confidence interval [CI] 2.62-2.79); emergency room visits IRR=1.35 (95% CI 1.31-1.38); outpatient visits IRR=1.29 (95% CI 1.29-1.30). Average annualized all-cause costs were also higher for HMB subjects than controls (mean difference $2,607, p<0.001). Costs associated with HMB claims represented 50% ($1,313) of the all-cause cost difference. Of HMB subjects, 63.2% underwent surgical treatment as initial therapy.
  
  
  CONCLUSIONS
  In this large matched-cohort study, an idiopathic diagnosis of HMB was associated with high rates of surgical intervention and increased healthcare resource use and costs.
authors.affiliation: Department of Obstetrics & Gynecology, Oregon Health and Science University, Women's Health Research Unit, Portland, Oregon 97239, USA. jensenje@ohsu.edu
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Jensen
authors.forename: Patrick
authors.initials: P
authors.lastname: Lefebvre
authors.forename: François
authors.initials: F
authors.lastname: Laliberté
authors.forename: Sujata P
authors.initials: SP
authors.lastname: Sarda
authors.forename: Amy
authors.initials: A
authors.lastname: Law
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pocoski
authors.forename: Mei Sheng
authors.initials: MS
authors.lastname: Duh
mesh_terms: D000293:Adolescent; D000328:Adult; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D017723:Drug Utilization Review / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006264:Health Benefit Plans, Employee; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data; D018868:Insurance, Disability / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D038801:International Classification of Diseases; D008137:Longitudinal Studies; D008595:Menorrhagia / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000601:surgery; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States