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Hysterectomy Rates Unchanged Despite Less Expensive Alternatives

Employer and patient economic interests ignored

Washington, DC - Women are still routinely offered hysterectomy as a primary treatment option despite newer less invasive and less costly alternatives that provide equal or better outcomes according to a new report just released by the not-for-profit National Women's Health Resource Center (NWHRC) at the 36th Global Congress of Minimally Invasive Gynecology in Washington, D.C.

According to the report, the "Cost-Effectiveness Comparisons of Treatments for Pelvic Health Disorders among US Women," the rate of hysterectomy has remained relatively unchanged for the past twenty-five years at about 600,000 per year. Since one in every three women will experience a pelvic health disorder by age 60, at these rates about 25 percent of women will have had a hysterectomy by age 60 and most will be treated with the open total abdominal procedure.

"Many women are still being treated for fibroids and menorrhagia (heavy menstrual bleeding) with hysterectomy, particularly the most invasive total abdominal hysterectomy (TAH), even though it comes with a long and painful recovery," said Elizabeth Battaglino Cahill, RN, executive vice president of the NWHRC. "While there are some cases where TAH is appropriate, women need to understand that there are less invasive options to hysterectomy that can get them back to their daily lives quicker and are actually more cost effective."

When comparing hysterectomy to treatment alternatives for menorrhagia, the report found that hysterectomy was the most expensive for both the initial procedure and for the total "episode of care."

Using cost estimates from the literature, the "episode of care" cost of hysterectomy was standardized at a value of $5,145 based on the 2007 Medicare reimbursement rates for hysterectomy that combined surgeon and facility reimbursement. The relative costs of treatment alternatives were then determined with the following results: oral medication at $4,116, LNG-IUS* at $2,933 and endometrial ablation at $2,830.

The report also revealed that employer and patient economic interests have been ignored in existing cost-effectiveness studies, because these studies do not include hidden costs such as lost work/productivity, disability and sick leave for the employer or lost wages and increased household costs to the patient.

*Levenorgestel-releasing intrauterine system

The employer of a 40-year old woman undergoing a total abdominal hysterectomy must bear an additional cost of $4,500 to $5,000 in lost work/salaries (disability/sick leave) due to the six-week recovery period. Laparoscopic vaginal forms of hysterectomy, such as laparoscopic supracervical hysterectomy, require about two weeks less recovery thereby reducing the cost to employers by about $1,600.

Costs to a family from a total abdominal hysterectomy whether or not a woman is employed outside the home, can total several thousand dollars to replace childcare and other household services.

The report provides support for leading clinicians and advocates who suggest that hysterectomy may remain the second most common non-obstetric surgical procedure in part because of its high Medicare reimbursement rate, which is often up to fifty percent more than other, less-invasive procedures. Economic factors affect how a patient selects or receives treatment for a health problem by influencing what health care providers recommend and what insurance plans will pay for.

"Economic factors aside, women do have the power to influence their healthcare by becoming more educated and asking their doctors about all treatment choices including minimally invasive options," said Ms. Cahill.

According to Dr. Bill Parker, UCLA School of Medicine, "If your doctor does not offer you alternatives to hysterectomy and minimally invasive options, consider finding another doctor who is skilled at these procedures."

The Lewin Group, the D.C.-based health and human services consulting firm that created the report, also looked at treatment costs for two other pelvic health disorders, stress urinary incontinence (SUI), and pelvic organ prolapse (POP) but found the literature was inadequate to establish their cost-effectiveness.

The report was commissioned by NWHRC as part of its "What's Going on Down There?" campaign aimed to educate women on how to maintain pelvic health throughout their lifetime and to provide information about common pelvic conditions and treatment options. The Web site is a tool for women to start their education and learn about what questions to ask, but ultimately, NWHRC encourages women to talk to their doctors and seek out second opinions if necessary to find the treatment that best fits their lifestyle.

This campaign was made possible through the support of ETHICON Women's Health & Urology, a division of ETHICON, Inc.

The National Women's Health Resource Center (NWHRC) is the leading independent health information source for women. The non-profit organization develops and distributes up-to-date and objective women's health information based on the latest advances in medical research and practice. NWHRC believes all women should have access to the most trusted and reliable health information. For more information, visit

The Lewin Group is a premier national healthcare and human services consulting firm with more than 35 years of experience finding answers and solving problems for leading organizations in the public, non-profit, and private sectors. The report "Cost-Effectiveness of Treatment Alternatives for Pelvic Health Disorders among U.S. Women" was submitted to the NWHRC in September 2007.

Cost-Effectiveness Comparisons of Treatments for Pelvic Health Disorders among US Women

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