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Background: Heavy menstrual bleeding (HMB) is one of the most common distressing complications of uterine fibroids (UF); however, data on the health care costs for treatments in women experiencing HMB associated with UF are lacking. The objective of this study was to compare the direct costs and treatments patterns for women diagnosed with UF+HMB, UF only, and HMB only in the United States. Materials and Methods: The study design was retrospective matched cohort study using claims data. Women, aged 18–51 years, comprising four cohorts (HMB only, UF only, UF+HMB, and controls) were identified in the IBM MarketScan® Commercial Claims and Encounters Database (October 1, 2007‒September 30, 2018) and matched by demographics and Charlson Comorbidity Index score. Baseline characteristics and treatments during the 12 months post-diagnosis were summarized descriptively. Costs (2018 U.S. dollars) during the post-diagnosis year were compared using analysis of variance. Results: Before matching, women with UF+HMB represented 54% of UF cases. Following diagnosis, 32% in the matched UF+HMB cohort had no treatment, 49% underwent surgeries/procedures with (12%) or without (37%) medications, and 18% received medications only. The mean all-cause total costs for UF+HMB ($16,762) exceeded that for UF only by 24% ($13,506) and HMB only by 50% ($11,135), and almost tripled the mean cost for the control cohort ($6,691) (all, p < 0.001). The mean diagnosis-related costs were significantly higher for UF+HMB ($8,741) than for UF only ($4,550) and HMB only ($3,081) (all, p < 0.0001). Surgery/procedure costs comprised 80% of diagnosis-related medical costs for UF+HMB. Conclusions: UF with HMB were associated with significant economic burden, driven primarily by surgical/procedural costs and treatment patterns. [ABSTRACT FROM AUTHOR]

Objective: Inclusion of minority women in gynecologic research is vital for preventing health care inequities and disparities. This research was conducted to determine how frequently race and ethnicity data were reported in oral presentations at the Society for Gynecologic Surgeons (SGS)'s annual meeting. Materials and Methods: The abstracts and articles associated with SGS oral presentations between 2016 and 2020 were reviewed. Data regarding the numbers of subjects and reported races and ethnicities were extracted from each study. The proportion of studies that reported data about race and ethnicity was calculated. The racial and ethnic distributions of subjects within the studies that reported race and ethnicity were compared to distributions in the U.S. census data. Results: The inclusion criteria were met by 72/92 available abstracts and 28/37 available, articles. Data were reported on participants' race in 10/72 (13.9%) abstracts and 21/28 (75.0%) articles. Ethnicity was reported in 3/72 (4.2%) abstracts and 14/28 (50.0 %) articles. In the abstracts and articles that did report on race, races other than White were underrepresented, compared to the U.S. population. Conclusions: Most research abstracts at SGS annual meetings did not include race or ethnicity data. SGS articles were more likely to report these data but did not represent the the U.S. population diversity accurately. (J GYNECOL SURG 38:241) [ABSTRACT FROM AUTHOR]

Objective: The goal of this research was to evaluate trends in gynecologic surgical reimbursement and to determine the factors affecting compensation. Materials and Methods: Procedure codes representing a comprehensive list of gynecologic surgical procedures were used to calculate the mean annual reimbursements from 2012 to 2017. Medicare compensation trends for all gynecologic procedures and trends for hysterectomies were evaluated with and without adjustment for inflation, using data from the Bureau of Labor and Statistics. The impact of the constituent components of physician billing was evaluated using linear regression. Results: Overall gynecologic surgical billing was flat with an insignificant increase of $12–$18 (2.5%–4.0%) during the study period. While the conversion factor increased significantly (5.2%) over time, the other major inputs to billing were flat. The most important determinant of compensation was the work relative value unit (wRVU). Using a regression model, a 1-point increase in the wRVU increased billing by $36.87. Laparoscopic hysterectomy reimbursement decreased significantly over time (p = 0.001). The mean reimbursement for laparoscopic hysterectomies dropped by 14.2% after changes to the relative value assignment were adjusted for these procedures. Conclusions: Gynecologic surgical reimbursement has been essentially flat over time. Reimbursement for laparoscopic hysterectomy has declined over time significantly. This inequity will only be magnified as hysterectomies shift to minimally invasive techniques. The most-effective method to maintain or improve overall gynecologic surgical compensation is to increase the assigned relative value unit for high-volume procedures such as hysterectomy. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to describe surgical treatment patterns among women with newly diagnosed uterine fibroids (UF). A secondary objective was to estimate the medical costs associated with other common surgical interventions for UF. Claims-based commercial and Medicare data (2011-2016) were used to identify women aged ≥30 years with continuous enrollment for at least 12 months before and after a new diagnosis of UF. Receipt of a surgical or radiologic procedure (hysterectomy, myomectomy, endometrial ablation, uterine artery embolization, and curettage) was the primary outcome. Health care resource utilization and costs were calculated for women with at least 12 months of continuous enrollment following a UF surgical procedure. Among women who met selection criteria, 31.7% of patients underwent a surgical procedure; 20.9% of these underwent hysterectomy. An increase was observed over time in the percentage of women undergoing outpatient hysterectomy (from 27.0% to 40.2%) and hysteroscopic myomectomy (from 8.0% to 11.5%). The cost analysis revealed that total health care costs for hysteroscopic myomectomy ($17,324) were significantly lower ( P < 0.001) than those for women who underwent inpatient hysterectomy ($24,027) and those for women undergoing the 3 comparison procedures. Hysterectomy was the most common surgical intervention. Patients undergoing inpatient hysterectomy had the highest health care costs. Although less expensive, minimally invasive approaches are becoming more common; they are performed infrequently in patients with newly diagnosed UF. The results of this study may be useful in guiding decisions regarding the most appropriate and cost-effective surgical treatment for UF. [ABSTRACT FROM AUTHOR]

Objective: The United States Food and Drug Administration (FDA) Manufacture and User Device Experience (MAUDE) Database houses reports of deaths, injuries, and malfunctions related to FDA-approved devices. This article evaluates the 10-year statistics from MAUDE related to robotic gynecologic surgery. Materials and Methods: This study is a database analysis. The MAUDE database was queried for events occurring between 2003 and 2012. The following information was abstracted: date of surgery; report date; type of surgery; indication; injury sustained; interventions required; device malfunction; and involvement in legal proceedings. Results: During the 10 years studied, 455 injuries and 177 malfunctions were reported. Reporting increased over time. Gynecologic cases represented 61% of all reported robotic injuries; 81% of these led to legal proceedings. The most common gynecologic procedure resulting in injury was hysterectomy ( n=399, 87%). Common complications included ureteral injuries (19%), infections (18%), and small-bowel injuries (16%). This resulted in 435 interventions, most commonly ureteral reimplantation (14%), bowel resection or repair (10%), and vaginal cuff closure (13%). Ninety-three device-related deaths were reported; 30 were associated with gynecologic surgeries. The most common cause of gynecologic procedure-related death was sepsis with or without bowel injury (28%) followed by hemorrhage (18%). Fifty adverse events resulted from 177 robot malfunctions. Conclusions: Reporting of robotic injuries, deaths, and malfunctions to the FDA is steadily increasing; however, as reporting in the MAUDE system is voluntary, the true incidence is unknown. Compulsory reporting would allow identification of absolute risks associated with robotic surgery and lead to improved root-cause analyses. (J GYNECOL SURG 31:331) [ABSTRACT FROM AUTHOR]