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Financial and Quality-of-Life Burden of Dysfunctional Uterine Bleeding Among Women Agreeing To Obtain Surgical Treatment

2008; Elsevier BV; Volume: 19; Issue: 1 Linguagem: Inglês

10.1016/j.whi.2008.07.002

1878-4321

Kevin D. Frick, Melissa A. Clark, Donald M. Steinwachs, Patricia Langenberg, Dale W. Stovall, Malcolm G. Munro, Kay Dickersin,

Uterine Myomas and Treatments

Purpose 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 χ2 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. Conclusion The financial and quality-of-life effects of DUB represent a substantial burden. 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. 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 χ2 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. 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. The financial and quality-of-life effects of DUB represent a substantial burden.