How Much Are Your Fibroids Costing You?
Alicia Armeli

Women with uterine fibroids pay thousands of dollars more each year in health care costs compared to their healthy peers, a collection of studies show.1

Uterine fibroids, a non-cancerous tumor that grows within the muscle tissue of the uterus, affects nearly 70% of white women and more than 80% of black women by age 50.2 Many women with fibroids won’t experience symptoms, but for those who do, heavy menstrual cycles, pelvic pressure, painful intercourse, and urinary dysfunction are common, causing as many as half to seek treatment.1

To understand what it means to have fibroids from a cost perspective, a team of researchers led by Ahmed M. Soliman, MD, PhD, associate director of Health Economics and Outcomes Research at AbbVie, Inc., analyzed a collection of studies from around the globe that were published between January 2000 and November 2013.1  Direct costs and indirect costs of uterine fibroids were recorded. Charges accrued as a result of direct patient care, such as drug costs, procedure fees, and medical service costs were considered direct costs. Indirect costs included those related to loss of work and productivity.

“Given the high prevalence of uterine fibroids, the associated debilitating symptoms that affect daily activities and the invasiveness of treatment options, the economic burden of uterine fibroids is considerable,” the team writes.1

Results showed the following:1

  • Direct costs in the year after fibroid diagnosis ran an average of over $9,000 per patient.
  • Indirect costs totaled approximately $2,400-$15,500 per patient.
  • Total costs—that included direct and indirect charges—ranged from about $11,700-$25,000 per patient per year after diagnosis or surgery.
  • Compared to their healthy peers, women with fibroids have an additional annual cost of $2,200-$16,000.

Although fees varied across the board, this information showcased the significant cost of uterine fibroids to health care payers and society. In the United States alone, total direct costs soared well into the billions, with a handful of studies estimating between $3.5 billion and $10.3 billion in a single year.1

A sizeable chunk goes to pay for fibroid treatments, which include hysterectomy or the surgical removal of the uterus. Myomectomy is another surgical option that involves keeping the uterus but removing the fibroids. A gynecologist performs both of these options.

Non-surgical treatments include uterine fibroid embolization (UFE), a minimally invasive procedure performed by an interventional radiologist. Tiny particles are injected into the uterine arteries, blocking blood flow to the fibroids. Once deprived of a blood supply, fibroids shrink and symptoms subside.

Endometrial ablation, another nonsurgical procedure that was investigated, is performed by a gynecologist and destroys the lining of the uterus. Ablation doesn’t treat fibroids, but it may help to decrease fibroid-related heavy menstrual bleeding. Medications that either control symptoms or temporarily reduce fibroid size were also discussed.

Not included in these numbers is the monthly cost of menstrual products, which can be a significant financial burden to women who experience heavy fibroid-related menstrual bleeding. Previous to successful treatment with UFE, a patient named Carmen, who wasn’t involved in the study, admitted to wearing multiple products at a time during her period to absorb her heavy flow. This included a tampon, pads, an adult diaper, and Spanx® to support it all.

“I would have a regular maxi-pad in the seat of the Spanx just in case the super absorbency tampon, the ultra long maxi-pads, and the Spanx couldn’t keep it together,” Carmen tells Ask4UFE. “I also had all that stuff in my bag just in case I had to change, which was about every hour.”

Several patient characteristics influenced cost.1  For example, increasing age and having other chronic conditions like heart failure, diabetes, obesity, high blood pressure, and pulmonary disease increased hospital length of stay and costs. Black women and those of Asian or Pacific Island race were also observed to have longer hospital stays.

The researchers concluded that although these results shed light on the cost of fibroids, more studies are needed to understand the true financial impact of this disease and “elucidate fully the economic burden…including burden to patients and the entirety of indirect costs.”1

ABOUT THE AUTHOR   Alicia Armeli is a freelance writer and editor, registered dietitian nutritionist, and certified holistic life coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. She is a paid consultant of Merit Medical.

REFERENCES

  1. Soliman, A. M., Yang, H., Du, E. X., et al. (2015). The direct and indirect costs of uterine fibroid tumors: A systematic review of the literature between 2000 and 2013. Am J Obstet Gynecol, Aug;213(2):141-160.
  2. Baird, D. D., Dunson, D. B., Hill, M. C., et al. (2003). High cumulative incidence of uterine leiomyoma in black and white women: Ultrasound evidence. Am J Obstet Gynecol, Jan;188(1):100-107.
New Pain Management Protocol Decreases Need for Opioids Among UFE Patients
Alicia Armeli

Up to half of women with uterine fibroids will seek treatment for bothersome symptoms like heavy periods, severe bloating, and painful sex.1 One such treatment is uterine fibroid embolization (UFE). An effective nonsurgical approach, UFE has shown to offer relief to nearly nine out of ten women treated.2

Despite these advantages, a downside to UFE is reported pelvic pain and cramping that may follow the procedure. Typically lasting up to 12 hours, this post-UFE pain may require opioid medication, also called narcotics, to provide relief.3 A team of researchers at Pennsylvania Hospital in Philadelphia, PA, found that performing UFE from the wrist—an approach called transradial access—combined with a nerve block targeting nerves in the lower back that supply sensation to the uterus and trigger post-UFE pain may reduce the need for opioids after the procedure.4

The study involved 79 women who underwent the combined treatment.4 Results showed that transradial UFE had a 97% technical success rate. The nerve block—which targeted the superior hypogastric nerve plexus—was successful in all but one patient. Of these 78 patients, nearly half (49%) didn’t require opioid medications following the procedure. The researchers also found that by using this protocol, patients were discharged home in about two and a half hours. Six patients returned five days later, needing treatment for uncontrolled pain or nausea.

UFE has traditionally been performed through the femoral artery in the groin area, but now—with a transradial option—UFE can access fibroids from the radial artery in the wrist. Doctors called interventional radiologists begin by making a nick in the wrist and inserting a slim catheter into the radial artery. Under the guidance of magnetic resonance imaging (MRI), the catheter is then threaded into the uterine vessels that supply fibroids with blood. Tiny particles are injected, plugging these vessels. Without a blood supply, fibroids begin to shrink and die, and symptoms start to improve.

Using the wrist to perform UFE has been shown to boost patient comfort immediately after the procedure.5 Patients have reported that transradial advantages such as being able to sit up in a comfortable position and get out of bed to use the toilet after the procedure have improved the overall patient experience.5

UFE pain management protocols vary but involve medication, typically opioids, administered intravenously (IV), through patches, and/or orally. Opioids work by blocking pain signals sent from the body through the spinal cord to the brain.6 In contrast, a nerve block is a regional anesthesia. Using specialized X-ray equipment, a small needle is used to inject pain medication near a cluster of nerves along the spinal cord, numbing only the part of the body affected by pain.7 Research has shown that complications are rare.3

This combined approach to UFE has many patient advantages. But as with any medical procedure, it’s important to talk to your doctor about whether you’d make a good candidate for this line of treatment and about any risks involved.

ABOUT THE AUTHOR Alicia Armeli is a freelance writer and editor, registered dietitian nutritionist, and certified holistic life coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad, and volunteering in her community. She is a paid consultant of Merit Medical.

REFERENCES

  1. Soliman, A. M., Yang, H., Du, E. X., et al. (2015). The direct and indirect costs of uterine fibroids tumors: A systematic review of the literature between 2000 and 2013. Am J Obstet Gynecol, Aug;213(2):141-160.
  2. Silberzweig, J. E., Powell, D. K., Matsumoto, A. H., et al. (2016). Management of uterine fibroids: A focus on uterine-sparing interventional techniques. Radiology, Sep;280(3):675-692.
  3. Boucher, L., Bahir, A., Yoon, J., et al. (2016). Superior hypogastric nerve block for acute pain control in uterine fibroid embolisation. J Vasc Interv Radiol, March;27(3):S285-S286.
  4. Maratto, S., Alkhatib, S., Huang, J., et al. (2018). Trans-radial uterine artery embolization with superior hypogastric nerve block: Optimizing pain control and minimizing length of stay. [Abstract]. J Vasc Interv Radiol, Apr;29(4):S184.
  5. Resnick, N. J., Kim, E., Patel, R. S., et al. (2014). Uterine artery embolization using a transradial approach: Initial experience and technique. J Vasc Interv Radiol, Mar;25(3):443-447.
  6. American Society of Anesthesiologists. (n.d). What are opioids? Retrieved from https://www.asahq.org/whensecondscount/pain-management/opioid-treatment/what-are-opioids/
  7. American Society of Regional Anesthesia and Pain Medicine. (n.d.). Regional anesthesia for surgery. Retrieved from https://www.asra.com/page/41/regional-anesthesia-for-surgery