EXECUTIVE SUMMARY
Uterine fibroid embolization, a minimally invasive, image-guided treatment performed by interventional radiologists, is underutilized when compared to hysterectomies, according to data from a new nationwide study.
- The presence of uterine fibroid tumors is the most common indication cited for hysterectomy, representing more than 30% of such procedures. Research indicates the prevalence of ultrasound-identified tumors as 33% in women ages 40-60 years, compared to 11-18% in women ages 30-40 years and 4% in women ages 20-30 years.
- Uterine fibroid embolization rarely is performed in rural and smaller hospitals, according to the new study. Data indicate that there were more than 65 times as many hysterectomies performed than embolizations, despite data suggesting that embolizations result in lower costs and shorter hospital stays than hysterectomies.
Uterine fibroid embolization (UAE), a minimally invasive, image-guided treatment performed by interventional radiologists, is underutilized when compared to hysterectomies, according to data from a new nationwide study.1
Research data indicate the prevalence of ultrasound-identified tumors as 33% in women ages 40-60 years, compared to 11-18% in women ages 30-40 years and 4% in women ages 20-30 years.2 The presence of uterine fibroid tumors is the most common indication cited for hysterectomy, representing more than 30% of such procedures.3
To perform the new study, researchers analyzed data from the 2012 and 2013 Nationwide Inpatient Sample, the largest U.S. all-payer inpatient healthcare database. By tracking billing codes that identified hysterectomies and embolizations completed for the treatment of uterine fibroids, researchers could analyze how women were treated for this condition, the treatment costs, and the outcomes.
Uterine fibroid embolization rarely is performed in rural and smaller hospitals, according to the new study. Data indicate that there were more than 65 times as many hysterectomies performed than embolizations, despite data suggesting that embolizations result in lower costs and shorter hospital stays than hysterectomies.1
“These findings suggest there is a lack of awareness about this safe, effective, and less invasive therapy for uterine fibroids,” said Prasoon Mohan, MD, MRCS, assistant professor in the department of interventional radiology at the University of Miami Leonard M. Miller School of Medicine. “Interventional radiologists urge healthcare professionals to present patients with all available treatment options so that the patient can make an informed decision.”
According to the new study, use of uterine fibroid embolization resulted in shorter hospital stays (2.16 days for embolization vs. 2.32 days for hysterectomy), and lower short-term costs ($21,583 for embolization vs. $33,104 for hysterectomy).1
Study Procedure
An interventional radiologist performs a uterine fibroid embolization by inserting a thin catheter into the artery at the groin or wrist. By guiding the catheter to the fibroid’s blood supply, the radiologist can release small plastic or gelatin particles into the blood vessels that supply blood to the fibroids. The particles block the blood supply to the arteries that supply blood to the fibroids. The fibroid undergoes necrosis, softens, bleeds less, and shrinks. In addition to a high technical success rate and a low perioperative complication rate, research suggests uterine fibroid embolizations result in high short-term and long-term patient satisfaction and improvement of symptoms.4
However, in a 2014 Cochrane review, analysts reviewed randomized, controlled trials of uterine fibroid embolization vs. any medical or surgical therapy for symptomatic uterine fibroids. They found no clear evidence of a difference between uterine fibroid embolization and surgery in the risk of major complications, but noted that embolizations were associated with a higher rate of minor complications and an increased likelihood of requiring surgical intervention within two to five years of the initial procedure.5
National Analysis Explores Options
The Duke Clinical Research Institute in Durham, NC, is working with nine centers across the United States on a five-year project to evaluate the effectiveness of different treatment strategies for women with uterine fibroids. The project, a collaboration between the Patient-Centered Outcomes Research Institute and the Agency for Healthcare Research and Quality, is designed to help patients and clinicians make more informed choices about treatment options. (Contraceptive Technology Update reported on the study in its March 2016 article, “Elevated testosterone levels might increase risk of uterine fibroids.” Access it at: http://bit.ly/2mpiwC4.)
The study creators are focusing on developing a multicenter registry of women who have undergone surgical treatments for uterine fibroids. This registry, COMPARE-UF (Comparing Options for Management: Patient-centered REsults for Uterine Fibroids), will establish the infrastructure necessary to support patient-centered comparative clinical effectiveness research.
Some of the differences in rates between rural and urban centers may reflect the lack of trained radiologists able to perform the uterine fibroid embolization procedure in rural settings, notes Anita Nelson, MD, professor and chair of the obstetrics and gynecology department at Western University of Health Sciences in Pomona, CA.
REFERENCES
- Narayanan S, Gonzalez A, Echenique A, et al. Nationwide analysis of hospital characteristics, demographics, and cost of uterine fibroid embolization. Presented at the Society of Interventional Radiology Annual Scientific Meeting. Washington, DC; March 2017.
- Lurie S, Piper I, Woliovitch I, Glezerman M. Age-related prevalence of sonographically confirmed uterine myomas. J Obstet Gynaecol 2005;25:42-44.
- Myers ER, Barber MD, Gustilo-Ashby T, et al. Management of uterine leiomyomata: What do we really know? Obstet Gynecol 2002;100:8-17.
- Müller-Hülsbeck S. Long-term results after fibroid embolization. Radiologe 2008;48:660-665.
- Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev 2014; doi:10.1002/14651858.CD005073.pub4.
Use rates particularly low in small and rural hospitals, according to a recent report.
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