Why Fibroids Are Everyone’s Problem

April 21, 2015

Uterine fibroids, benign pelvic tumors that are also known as leiomyomas, are a nightmare for more than just the millions of women who endure the condition’s symptoms: the U.S. healthcare system also feels the pain. A 2011 study by Cardozo et. al quantified that pain, estimating the annual cost of uterine fibroids to the United States at between $5.9 and $34.4 billion, “more than breast cancer, colon cancer or ovarian cancer, and nearly one fifth the annual cost of diabetes”. The enormous economic burden of the condition led another group of researchers, Eltoukhi et. al, to conclude, “fibroid tumors should be considered a public health issue, given the magnitude of the problem and costs of health care for this disease.”

Estimating the real cost of fibroids to the U.S. healthcare system is no simple task. Multiple research studies have delivered a wide range of figures. To thoroughly understand the fiscal burden, estimates have to account for both direct costs—including hospitalizations, outpatient visits, surgical procedures and medical treatments—and indirect costs, like the lost work productivity that correlates with the condition of symptomatic uterine fibroids.

Examining the full economic impact of the condition, the Cardozo study considered both direct and indirect costs. The researchers estimated that between $4.1 and $9.4 billion is spent annually on medical treatments for fibroid patients. The range is fairly wide, due to the difference in cost between various fibroid treatment modalities; the more invasive surgical methods incur the greatest cost. “As approximately 200,000 hysterectomies and 30,000 myomectomies are performed annually for [fibroids],surgical costs alone contribute significantly to the total annual costs of this disease.”

However, healthcare costs are not the only expense contributing to fibroids’ fiscal impact: the Cardozo study found that lost work productivity accounted for the largest portion of the fibroids’ societal cost, potentially totaling as much as $17.2 billion dollars annually. Hartmann et. al determined that women with diagnosed with Uterine Fibroids were 3 times more likely to file a disability claim than their healthy counterparts. Furthermore, Lerner et. al, looked at work-performance limitations and productivity loss in women with untreated uterine fibroids and found that “symptomatic fibroids interfere substantially with women’s ability to function at work”.

Researchers in the Lerner study evaluated survey data from 58 women with symptomatic fibroids and 56 healthy women in a control group. They found that productivity loss related to absenteeism was 5.4% among women with fibroids versus 1.4% for women in the control group. The researchers also looked at ways in which having symptomatic fibroids impacted various aspects of women’s work performance, including time management, performance of mental and interpersonal job tasks, performance of physical tasks, and overall output. Their findings indicated that symptomatic uterine fibroids negatively impacted all aspects of the women’s job performance. The relative impact is represented in the chart below.

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The results of the Lerner study revealed that, on average, the work performance of fibroid sufferers was impaired 18% of the time, compared to 8% of the time for the average member of the control group. The study, which was published in the Journal of Occupational and Environmental Medicine in 2008, reported that, “the [group with fibroids] had mean at-work productivity deficits that, while lower than observed for primary care patient samples with major depressive disorder or osteoarthritis, are similar to those documented for clinic patients with diagnosed migraine headache”.

The U.S. Bureau of Labor Statistics reports that, “in 2013, women accounted for 51 percent of all workers employed in management, professional, and related occupations, somewhat more than their share of total employment (47 percent)”. Considering the high prevalence of fibroids among adult women, the societal impact of lost productivity, absenteeism, and disability claims attributable to fibroids is one we simply can’t afford to ignore.

The societal and economic impact of uterine fibroids also has a racial dimension. Multiple studies have observed that the incidence of fibroids is higher in African American women than in women of other races. The reason for the disparity in fibroids’ occurrence isn’t fully understood, but the problem is a big one: while it’s estimated that fibroids occur in as many as 70% of women, the incidence of fibroids in black women is even higher, with estimates reaching 80%.
Treated or untreated, the occurrence of fibroids has a particularly negative impact on women of color. African Americans are the “disproportionate majority” having surgery for fibroids, according to Moore et. al. Furthermore, race-based differences have been observed in health outcomes and responses to treatment: for example, African American women have a higher risk of post-surgical complications. Of those women studied by Lerner et. al whose symptomatic fibroids were untreated, women of color experienced greater productivity loss at work. The Lerner study reported that, “racial/ethnic minority status was associated with more difficulty managing physical and mental-interpersonal job tasks”.

A study by Eltoukhi et. al pointed to unequal access to care as an underlying factor. “Socioeconomic status and race influence access to appropriate health care. This disparity is a significant and controversial problem in the United States health care system, especially because access to some therapies is directly affected by insurance status and cost of the procedure. When hysterectomies are performed, white women and women of other racial groups with private insurance are more likely to undergo laparoscopic procedures, whereas African Americans, Hispanics, and women with Medicare coverage are more likely to undergo abdominal procedures, even for the same indication.”

The research team of Weiss et. al found a different explanation for the phenomenon, at least in terms of African American women’s higher likelihood of undergoing hysterectomy: they concluded that, “racial differences in the frequency of hysterectomy for benign conditions are consistent with differences in presenting symptoms, where African-American women seemingly have larger, more symptomatic fibroids”. While the reason for the disparity in treatment remains elusive, the implications have a direct and significant impact on the overall cost of fibroids to the U.S. health system.

Recovery time for a hysterectomy generally exceeds 4 weeks. That’s a lot of lost work days. The Cardozo study determined that “if the percentage of women undergoing hysterectomy was minimized as was the cost of lost work for these women, it would result in a 25.6% savings in the total annual costs due to uterine fibroids”. With that profound statistic in mind, we have reason to be hopeful: newer fibroid treatments such as the Acessa Procedure can effectively treat fibroids through minimally-invasive means, allowing for a faster recovery time. A study by Garza et. al showed that patients who underwent the Acessa Procedure were able to return to work or normal activities in an average of 3-4 days.

The increasing availability of less invasive treatment options that are associated with shorter recovery times give reason to be optimistic in the face of this public health crisis. While a faster recovery means less productivity loss related to fibroid treatment, it could also potentially minimize the productivity loss from untreated fibroid symptoms by reducing the consequences that commonly lead women to delay seeking treatment. If safe, effective, minimally invasive treatments are widely available and accessible to all women with uterine fibroids, the decision to seek treatment would likely be an easier one. In these ways, as fibroid treatment options improve, perhaps the economic burden that the condition creates will do the same.

Sources:

  1. Cardozo, E. et. al, “The Estimated Annual Cost of Uterine Leiomyomata in the United States”, American Journal of Obstetrics and Gynecology. 2011, doi:10.1016/j.ajog.2011.12.002
  2. Hartmann K.E. et al. “Annual costs associated with diagnosis of uterine leiomyomata”, Obstetrics and Gynecology. 2006;108:930 –937.
  3. Lerner,D. et. al, “Impaired Work Performance Among Women With Symptomatic Uterine Fibroids”JOEM. Oct. 2008; Vol.50(10):1149-1157
  4. U.S. Department of Labor and U.S. Bureau of Labor Statistics, “Women in the Labor Force: A Databook”. 2014 edition, 1052. Retrieved 4/15/15 from: http://www.bls.gov/opub/reports/cps/women-in-the-labor-force-a-databook-2014.pdf
  5. Moore, A.B. et. al, “Association of race, age and body mass index with gross pathology of uterine fibroids”, Journal of Reproductive Medicine. Feb. 2008; Vol.53(2):90-6
  6. Eltoukhi, H.M. et. al, “The health disparities of uterine fibroid tumors for African American women: a public health issue”, American Journal of Obstetrics and Gynecology. Mar 2014; Vol.210(3):194-9
  7. Weiss G. et. al, “Racial differences in women who have a hysterectomy for benign conditions”, Women’s Health Issues. May-Jun 2009;Vol.19(3):202–10
  8. Pitter, M.C. et. al, “The Impact of Different Surgical Modalities for Hysterectomy on Satisfaction and Patient Reported Outcomes” Interactive Journal of Medical Research. Jul-Sep. 2014; Vol. 3(3): e11.
  9. Garza, L. et. al, “Laparoscopic ultrasound-guided radiofrequency volumetric thermal ablation of symptomatic uterine leiomyomas: feasibility study using the Halt 2000 ablation system”, Journal of Minimally Invasive Gynecology. 2011;18(3):364–71.

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