scholarly journals Employer-perspective cost comparison of surgical treatments for abnormal uterine bleeding

2020 ◽  
Vol 9 (1) ◽  
pp. 67-77
Author(s):  
Jeffrey D Miller ◽  
Machaon M Bonafede ◽  
Scott K Pohlman ◽  
Aarathi Cholkeri-Singh ◽  
Kathleen A Troeger
Keyword(s):  
Indirect Costs ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Cost Comparison ◽  
Short Term ◽  
Study Results ◽  
Insurance Claims Data ◽  
Employer Perspective ◽  
The Difference ◽  
Surgical Treatments

Aim: To estimate direct and indirect costs of surgical treatment of abnormal uterine bleeding (AUB) from a self-insured employer's perspective. Methods: Employer-sponsored insurance claims data were analyzed to estimate costs owing to absence and short-term disability 1 year following global endometrial ablation (GEA), outpatient hysterectomy (OPH) and inpatient hysterectomy (IPH). Results: Costs for women who had GEA are substantially less than costs for women who had either OPH or IPH, with the difference ranging from approximately $7700 to approximately $10,000 for direct costs and approximately $4200 to approximately $4600 for indirect costs. Women who had GEA missed 21.8–24.0 fewer works days. Conclusion: Study results suggest lower healthcare costs associated with GEA versus OPH or IPH from a self-insured employer perspective.

scholarly journals Employer-Perspective Cost Comparison of Surgical Treatments for Abnormal Uterine Bleeding

2018 ◽  
Vol 21 ◽  
pp. S142
Author(s):  
JD Miller ◽  
MM Bonafede ◽  
Q Cai ◽  
SK Pohlman ◽  
KA Troeger
Keyword(s):  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Cost Comparison ◽  
Employer Perspective ◽  
Surgical Treatments

scholarly journals Abnormal Uterine Bleeding in Perimenopausal Age: Different causes and its relation with histopathology

2014 ◽  
Vol 13 (2) ◽  
pp. 135-139 ◽  
Author(s):  
Nazlima Nargis ◽  
Iqbal Karim ◽  
Khondaker Bulbul Sarwar
Keyword(s):  
Histopathological Examination ◽  
Medical Science ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Transvaginal Sonography ◽  
Age Group ◽  
Histopathological Findings ◽  
Medical College ◽  
Gynecology And Obstetrics ◽  
Study Results

Background: Abnormal uterine bleeding (AUB) is the most common reason for gynecological visits for perimenopausal bleeding and may account for more than 25% of all hysterectomies. Objective: This study was aimed to review the causes of abnormal uterine bleeding in perimenopausal women establishing the correlation with ultrasonographic and histopathological examinations. Study Method: This descriptive study was conducted in the department of gynecology and obstetrics, Ibn Sina Medical College, Dhaka during January to December 2012. Two hundred and eleven women were selected for this study, who admitted into the hospital with abnormal uterine bleeding in perimenopausal age. The clinical, ultrasonographic and histopathological findings of these women were evaluated in this study. Results: Menorrhagia was the major symptom (52.6%) irrespective of age and parity. All these women underwent D&C followed by either medical management or hysterectomy depending upon the diagnosis. The histopathological findings of endometrium were analyzed and confirmed as fibroid uterus (58.28%) and DUB (17.58%) correlated well with transvaginal sonography (TVS) and histopathological examination. Hysterectomy conferred other uterine lesions as adenomyosis (18.71%), endometrial polyp (4.81%) and malignancy (1.06%). Conclusion: Abnormal uterine bleeding in perimenopausal age group is a common but ill-defined entity which needs proper evaluation. Accurate diagnosis of the causative factors of AUB in this age group is of utmost importance so that appropriate management can be established early that leads the minimization of the patients’ sufferings. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18295 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.135-139

Comparison of direct and indirect costs of abnormal uterine bleeding treatment with global endometrial ablation and hysterectomy

2015 ◽  
Vol 4 (2) ◽  
pp. 115-122 ◽  
Author(s):  
Machaon M Bonafede ◽  
Jeffrey D Miller ◽  
Andrea Lukes ◽  
Nicole M Meyer ◽  
Gregory M Lenhart
Keyword(s):  
Indirect Costs ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Ablation ◽  
Uterine Bleeding ◽  
Direct And Indirect Costs

scholarly journals Comparison between Different Diagnostic Strategies in Low-Risk Reproductive Age and Pre-Menopausal Women Presenting Abnormal Uterine Bleeding

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 884
Author(s):  
Chiara Belcaro ◽  
Federica Scrimin ◽  
Alessandro Mangogna ◽  
Emanuele Filippo Galati ◽  
Stefania Biffi ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Low Risk ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Female Population ◽  
Diagnostic Strategies ◽  
Study Results

Abnormal uterine bleeding (AUB) is a common symptom in the female population, with an estimated prevalence of 10 to 30% in fertile age and up to 90% in perimenopausal women. In most cases, AUB is due to a benign cause. However, it can also be a symptom of atypical endometrial hyperplasia or endometrial cancer, a more common disease during menopause which can also affect women in their reproductive age. Considering the high prevalence of this symptom an appropriate diagnostic algorithm is needed. Concerns about the risks, pain, and stress associated with an endometrial biopsy and its impact on the healthcare system make the choice of AUB diagnostic strategy extremely relevant. Even if the scientific community agrees on the definition of AUB, International Guidelines show some differences in the management of women of reproductive age with AUB, especially regarding the age cut-off as an independent indication for endometrial biopsy. This study compared different diagnostic strategies to identify a diagnostic pathway with high sensitivity and specificity but low impact on the health system’s resources. The analysis was based on three diagnostic algorithms defined as part of the guidelines of leading scientific societies. Women of reproductive age with AUB (n = 625) and without risk of endometrial cancer were included in the study. Results showed that the best criterion to investigate AUB in women at low risk of endometrial cancer is not age cut-off but the presence or absence of focal endometrial pathology at the ultrasound and the response to the progestin therapy. This approach makes it possible to perform fewer outpatient hysteroscopic biopsies without excluding positive cases from the examination.

scholarly journals SUN-296 Acromegaly Significantly Impacts Employees’ Health Benefit Costs and Increases Work Absenteeism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Kevin C j Yuen ◽  
Kathryn A Munoz ◽  
Richard Alan Brook ◽  
John D Whalen ◽  
Ian A Beren ◽  
...  
Keyword(s):  
Consumer Price Index ◽  
Work Productivity ◽  
Health Benefit ◽  
Indirect Costs ◽  
Pituitary Surgery ◽  
Short Term ◽  
Work Absenteeism ◽  
Productivity Data ◽  
The Difference ◽  
The Impact

Abstract Background: Acromegaly (ACRO) is a rare, chronic disorder of growth hormone hypersecretion associated with increased morbidity that can affect work productivity. Data on ACRO employees’ health costs and work absenteeism are limited. Aims: To assess the impact of ACRO on employees’ health benefit costs and absenteeism. Methods: A US employee database of prescription (Rx) drug, medical claims, and absenteeism (payment and time) from Jan 2010 to Apr 2019 was analyzed. Employees with the diagnosis (Dx) of ACRO were identified based on claims with ICD-9/-10 codes 253.0x/E22.0. A 12 month study period followed each employee’s first ACRO Dx in the database (the index date). ACRO patients in the study had ≥ 2 ACRO Dxs > 30 days apart, or 1 ACRO Dx plus either a pituitary adenoma Dx or a pituitary surgery or radiosurgery claim during the study period. Controls were matched to each ACRO employee on demographic, job-related variables, region, and Charlson comorbidity index (CCI) score. Costs were adjusted using the general Consumer Price Index (CPI), medical CPI, and Rx cost CPI. Outcomes included direct costs (medical and Rx), indirect costs (absence payments by benefit type), and lost time (absences by benefit type). Outcomes were analyzed using two-part regression models (logistic followed by generalized linear) for each outcome, controlling for demographic and job-related variables, region, and CCI scores. Data are shown as likelihood or mean ± standard error. Findings are significant at P < 0.05. Results: Participants were 18–65 yr old with continuous eligibility for medical and Rx benefits for the study period. Forty seven ACRO patients and 940 controls were identified. ACRO employees were similar to the controls in most demographic (age, gender, race) and job-related variables (tenure, full-/part-time status, exempt status, salary), but had a higher CCI (0.60 ± 0.15 vs 0.30 ± 0.03; P = 0.029) and a higher incidence of chronic lung disease (31.9 vs 17.4%; P = 0.012), hyperlipidemia (27.7 vs 16.0%, P = 0.035), arthritis (19.1 vs 3.7%), diabetes (31.9 vs 8.3%), hypertension (40.4 vs 13.6%), and thyroid disease (31.9 vs 8.9%) (P < 0.0001). Patients with ACRO were 64.3% more likely to have undergone an MRI (P < 0.0001).Total indirect costs (including sick leave and disability) were higher for ACRO patients ($10,530 vs $1,157; P < 0.05) with both short-term and long-term disability comprising 96% of the difference. Compared with employees without ACRO, employees with ACRO used more short-term disability (10.9 vs 0.9 days; P = 0.0076) and had more total days absent from work (12.7 vs 3.3 days; P < 0.05). Conclusions: Our findings indicate that ACRO has far-reaching implications on direct and indirect employee health benefit costs and increased work absenteeism. Awareness by employers of ACRO-induced increased absenteeism is important to tailor working conditions and to prevent unrealistic work expectations.

Endometrial biopsy in women with abnormal uterine bleeding: inadequate and unassessable categorisation is not clinically relevant

2014 ◽  
Vol 67 (8) ◽  
pp. 673-677 ◽  
Author(s):  
Ayman A A Ewies ◽  
Kadry A A Shaaban ◽  
Reena Merard ◽  
Ulises Zanetto
Keyword(s):  
Endometrial Thickness ◽  
Abnormal Uterine Bleeding ◽  
Final Diagnosis ◽  
Median Number ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Initial Finding ◽  
Significant Difference ◽  
The Difference ◽  
Clinical Records

AimsInadequate endometrial biopsy comprises a dilemma for gynaecologists and histopathologists alike. This study was conducted to assess the clinical merit of classifying scant endometrial biopsy into inadequate and unassessable using McCluggage criteria.MethodsWe retrospectively classified 268 endometrial biopsies, initially reported as inadequate, into inadequate (n=74) and unassessable (n=174) using McCluggage criteria after excluding 20 cases; all taken from patients aged ≥50 years with abnormal uterine bleeding attending Sandwell and West Birmingham Hospitals, UK from 1 January 2007 until 30 September 2012. The electronic clinical records were reviewed to find out the consequent clinical decisions and final outcomes. The follow-up period was 15 months after including the last patient.ResultsThe median age was 57 years (range: 50–97), and the median number of visits to hospital till the diagnosis was achieved was 2 (range: 1–4). The final diagnosis of endometrial hyperplasia or cancer was reported in 9 cases; 5 (7.1%) with an initial finding of inadequate and 4 with unassessable (2.4%); the difference was statistically insignificant (p=0.13). More patients in the inadequate category (82.4%) underwent further investigations when compared with the unassessable category (68.4%); the difference was statistically significant (p=0.029). There was no statistically significant difference in the inadequate to unassessable ratio when the endometrial thickness was ≥5 mm or <5 mm within the Pipelle group (p=0.46) or the curettage group (p=0.34).ConclusionsOur findings suggest that categorising scant endometrial specimens into inadequate or unassessable has no clinical implications. The gynaecologist should interpret the histopathology report in the light of clinical scenario.

Abnormal Menstrual Bleeding

2018 ◽  
Author(s):  
Chu Hsiao ◽  
Leanne Dumeny ◽  
Candice P. Holliday ◽  
Lisa Spiryda
Keyword(s):  
Intrauterine Device ◽  
Age Groups ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Artery Embolization ◽  
Ovulatory Dysfunction ◽  
Menstrual History ◽  
Inflammatory Drugs ◽  
Medical Therapies ◽  
Surgical Treatments

Abnormal uterine bleeding (AUB) is a common presentation that can occur in all age groups. AUB is an umbrella term for any uterine bleeding that occurs outside a woman’s normal pattern in volume, regularity, and/or timing. AUB is described by using frequency, regularity, duration, and volume or by using PALM-COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy and premalignant conditions; Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified). Workup for AUB comprises a history (with a detailed menstrual history), physical examination (including a pelvic and bimanual examination), lab tests, and imaging (primarily transvaginal ultrasonography). For treatment, medical therapies should be considered before surgical therapies, especially when fertility is desired. The decisions for treatment are based on etiology, fertility concerns, contraindications, or patient preference. Of the medical therapies, there are hormonal and nonhormonal therapies. The most common treatments for AUB are levonorgestrel intrauterine device, tranexamic acid, oral contraceptives, and nonsteroidal anti-inflammatory drugs. The most common surgical treatments are myomectomy, endometrial ablation, uterine artery embolization, and hysterectomy.   This review contains 7 figures, 10 tables and 45 references Key words: abnormal uterine bleeding, adenomyosis, contraceptives, endometrial, fibroids, hysterectomy, menorrhagia

scholarly journals STUDY TO CORRELATE CLINICAL AND HISTOPATHOLOGICAL FINDINGS OF ABNORMAL UTERINE BLEEDING ACCORDING TO FIGO’S PALM-COEIN CLASSIFICATION

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Disha Patel ◽  
Kanaklata D Nakum ◽  
Aditi Vithal
Keyword(s):  
Clinical Diagnosis ◽  
Classification System ◽  
International Comparisons ◽  
Indirect Costs ◽  
Abnormal Uterine Bleeding ◽  
Final Diagnosis ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Histopathological Findings ◽  
Group A

Abnormal uterine bleeding (AUB) is a common and debilitating condition with high direct and indirect costs. AUB frequently co-exists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a menstrual bleeding complaint.  Abnormal uterine bleeding (AUB) is one of the common presenting complaints encountered by a Gynaecologist. The International Federation of Gynaecology and Obstetrics working group on menstrual disorders has recently developed a classification system (PALM–COEIN) for causes of the AUB in non-gravid women. The present study was conducted with the aim to study and analyse the structural (PALM) and the functional (COEIN) component of the PALM–COEIN system of AUB in perimenopausal age group. A total of 200 perimenopausal women (aged 40 years and above till 1 year beyond menopause) who were admitted with complaints of abnormal uterine bleeding comprised the study population. Clinical diagnosis and allocation to PALM–COEIN was done. Endometrial biopsy and hysterectomy specimens (wherever applicable) were obtained and sent for histopathology. As per the histopathological findings, possible underlying causes were categorized. Clinical diagnosis was then correlated with histopathology-based final diagnosis. PALM and COEIN components contributed almost equally for AUB when assessed clinically. The histological examination revealed significantly more cases of PALM (structural or anatomical) component of AUB. The PALM COEIN classification system helps us in understanding various etiological causes of AUB and can be used by clinicians and researchers for international comparisons. Keywords: Abnormal uterine bleeding (AUB) , PALM–COEIN . Perimenopause

Abnormal Menstrual Bleeding

2020 ◽  
Author(s):  
Chu Hsiao ◽  
Leanne Dumeny ◽  
Candice P. Holliday ◽  
Lisa Spiryda
Keyword(s):  
Intrauterine Device ◽  
Age Groups ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Artery Embolization ◽  
Ovulatory Dysfunction ◽  
Menstrual History ◽  
Inflammatory Drugs ◽  
Medical Therapies ◽  
Surgical Treatments

Abnormal uterine bleeding (AUB) is a common presentation that can occur in all age groups. AUB is an umbrella term for any uterine bleeding that occurs outside a woman’s normal pattern in volume, regularity, and/or timing. AUB is described by using frequency, regularity, duration, and volume or by using PALM-COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy and premalignant conditions; Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified). Workup for AUB comprises a history (with a detailed menstrual history), physical examination (including a pelvic and bimanual examination), lab tests, and imaging (primarily transvaginal ultrasonography). For treatment, medical therapies should be considered before surgical therapies, especially when fertility is desired. The decisions for treatment are based on etiology, fertility concerns, contraindications, or patient preference. Of the medical therapies, there are hormonal and nonhormonal therapies. The most common treatments for AUB are levonorgestrel intrauterine device, tranexamic acid, oral contraceptives, and nonsteroidal anti-inflammatory drugs. The most common surgical treatments are myomectomy, endometrial ablation, uterine artery embolization, and hysterectomy. This review contains 7 figures, 11 tables and 49 references Key words: abnormal uterine bleeding, adenomyosis, contraceptives, endometrial, fibroids, hysterectomy, menorrhagia

scholarly journals Distribution of causes of abnormal uterine bleeding using new FIGO classification system-PALM COEIN: a rural tertiary hospital based study

2017 ◽  
Vol 6 (8) ◽  
pp. 3523 ◽  
Author(s):  
Kalpana Betha ◽  
Lavanya Malavatu ◽  
Sreeveena Talasani
Keyword(s):  
Classification System ◽  
International Comparisons ◽  
Abnormal Uterine Bleeding ◽  
Tertiary Hospital ◽  
Uterine Bleeding ◽  
Reproductive Age ◽  
Histopathological Diagnosis ◽  
Common Cause ◽  
Tertiary Teaching ◽  
The Difference

Background: Abnormal Uterine Bleeding (AUB) is a significant debilitating clinical condition. It may have a significant impact on women’s quality of life with significant burden to the country’s economy. The primary aim was to categorize women with Abnormal Uterine Bleeding (AUB) according to PALM COEIN classification system and to correlate the clinical diagnosis and histopathologic features of various causes of AUB.Methods: A retrospective study was carried out on 250 non-gravid reproductive age women between 25-45 years with complaints of AUB at Mediciti Institute of Medical Sciences, a rural tertiary teaching hospital during the period January 2014 to December 2015.Results: The PALM and COEIN groups accounted for 60.4% and 39.6% respectively. Leiomyoma was the most common cause of AUB (30.4%) and Ovulatory disorders was the 2nd most common cause of AUB (13.6%). A total of 172 (68.8%) were classified as having chronic AUB and 78(31.2%) as having acute AUB. In AUB-L, the difference in clinical and histopathological diagnosis was significant (p=0.03).Conclusions: Structural causes of AUB contributed more to the cause of AUB. The PALM COEIN classification system helps us in understanding various etiological causes of AUB and can be used by clinicians and researchers for international comparisons. 

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