SAN FRANCISCO — Compared with hysterectomy and myomectomy, uterine fibroid embolization actually bolsters rather than bleeds the health care system, Anne Bussard, M.D., reported.
“Fibroid embolization is financially advantageous for the health care system, the insurer, and the radiologist. The only economic loser is the gynecologist, who loses a $1,000 surgical fee every time a woman chooses an embolization over a myomectomy or hysterectomy,” said Dr. Bussard of the Jefferson Fibroid Center at Jefferson Medical College, Philadelphia.
The study, which she presented at the annual meeting of the American College of Obstetricians and Gynecologists, analyzed the costs and reimbursements associated with 299 women at her center who underwent abdominal hysterectomy, 105 who had abdominal myomectomy, and 136 who had uterine fibroid embolization (UFE) for symptomatic fibroids.
The baseline characteristics of all patients did not differ significantly except for their mean age, which was oldest in the hysterectomy group (48 years), followed by the UFE group (44 years) and then the myomectomy group (37 years).
The study looked at direct costs (such as nursing costs and operating room time), indirect costs (such as administrative costs) and hospital and physician reimbursements for each procedure and then calculated a net hospital income. “This is the first study of these treatments of which we are aware that calculated the net hospital income, defined as the total reimbursement from the insurance company minus the total cost,” Dr. Bussard said.
Although the insurer's reimbursement was less for UFE procedures ($2,764) than for hysterectomies ($5,135) or myomectomies ($4,961), total hospital costs, direct and indirect, were significantly less for UFE, at $2,707 versus $5,676 for myomectomy and $5,707 for hysterectomy.
As a result, the hospital lost money on both hysterectomies and myomectomies ($572 and $715, respectively), while it made an average of $57 on each UFE.
“Uterine fibroid embolization makes money—and in terms of professional costs, radiologists are reimbursed better than ob.gyns. For a short, same-day procedure, radiologists make $1,306 per embolization, and for a hysterectomy or myomectomy, which can take several hours and 2–3 days of postoperative care, ob.gyns. make $979 to $1,078,” said Dr. Bussard, a resident in obstetrics and gynecology.
One study found the cost of UFE to be higher than that of hysterectomy ($8,223 vs. $6,046), but two other studies favor UFE. One comparing UFE with myomectomy found while hospital costs were lower for UFE, compared with myomectomy ($3,193 vs. $5,598) and physician costs were higher ($2,220 vs. $1,611), the overall costs were less for UFE ($6,708 vs. $7,630).
Another study comparing UFE with abdominal myomectomy, total vaginal hysterectomy, or total abdominal hysterectomy found UFE had the lowest cost.