Simrit K Warring1, Bijan Borah2, James Moriarty2, Rachel Gullerud2, Maureen A Lemens1, Christopher Destephano3, Mark E Sherman4, Jamie N Bakkum-Gamez5. 1. Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, United States of America. 2. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States of America. 3. Division of Minimally Invasive Gynecology, Mayo Clinic, Jacksonville, FL, United States of America. 4. Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States of America. 5. Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, United States of America; Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, United States of America. Electronic address: bakkum.jamie@mayo.edu.
Abstract
OBJECTIVE: The evaluation of women with perimenopausal abnormal uterine bleeding (AUB) and postmenopausal bleeding (PMB) to detect endometrial cancer (EC) and its precursors is not standardized and can vary widely. Consequently, costs associated with the workup and management undoubtedly vary. This study aimed to quantify costs of AUB/PMB evaluation to understand the healthcare burden associated with securing a pathologic diagnosis. METHODS: Women ≥45 years of age presenting to a single institution gynecology clinic with AUB/PMB for diagnostic workup were prospectively enrolled February 2013-October 2017 for a lower genital tract biospecimen research study. Clinical workup of AUB/PMB was determined by individual provider discretion. Costs of care were collected from administrative billing systems from enrollment to 90 days post enrollment. Costs were standardized and inflation-adjusted to 2017 US Dollars (USD). RESULTS: In total, there were 1017 women enrolled with 5.6% diagnosed with atypical hyperplasia or endometrial cancer (EC). Within the full cohort, 90-day median cost for AUB/PMB workup and management was $2279 (IQR $512-4828). Among patients with a diagnostic biopsy, median 90-day costs ranged from $2203 (IQR $499-3604) for benign or disordered proliferative endometrium (DPE) diagnosis to $21,039 (IQR $19,084-24,536) for a diagnosis of EC. CONCLUSIONS: The costs for diagnostic evaluation of perimenopausal AUB and PMB vary greatly according to ultimate tissue-based diagnosis. Even reassuring benign findings that do not require further intervention-the most common in this study's cohort-yield substantial costs. The development of sensitive, specific, and more cost-effective diagnostic strategies is warranted.
OBJECTIVE: The evaluation of women with perimenopausal abnormal uterine bleeding (AUB) and postmenopausal bleeding (PMB) to detect endometrial cancer (EC) and its precursors is not standardized and can vary widely. Consequently, costs associated with the workup and management undoubtedly vary. This study aimed to quantify costs of AUB/PMB evaluation to understand the healthcare burden associated with securing a pathologic diagnosis. METHODS: Women ≥45 years of age presenting to a single institution gynecology clinic with AUB/PMB for diagnostic workup were prospectively enrolled February 2013-October 2017 for a lower genital tract biospecimen research study. Clinical workup of AUB/PMB was determined by individual provider discretion. Costs of care were collected from administrative billing systems from enrollment to 90 days post enrollment. Costs were standardized and inflation-adjusted to 2017 US Dollars (USD). RESULTS: In total, there were 1017 women enrolled with 5.6% diagnosed with atypical hyperplasia or endometrial cancer (EC). Within the full cohort, 90-day median cost for AUB/PMB workup and management was $2279 (IQR $512-4828). Among patients with a diagnostic biopsy, median 90-day costs ranged from $2203 (IQR $499-3604) for benign or disordered proliferative endometrium (DPE) diagnosis to $21,039 (IQR $19,084-24,536) for a diagnosis of EC. CONCLUSIONS: The costs for diagnostic evaluation of perimenopausal AUB and PMB vary greatly according to ultimate tissue-based diagnosis. Even reassuring benign findings that do not require further intervention-the most common in this study's cohort-yield substantial costs. The development of sensitive, specific, and more cost-effective diagnostic strategies is warranted.
Authors: Kristen A Matteson; Christina A Raker; Melissa A Clark; Kevin D Frick Journal: J Womens Health (Larchmt) Date: 2013-09-19 Impact factor: 2.681
Authors: Jamie N Bakkum-Gamez; Nicolas Wentzensen; Matthew J Maurer; Kieran M Hawthorne; Jesse S Voss; Trynda N Kroneman; Abimbola O Famuyide; Amy C Clayton; Kevin C Halling; Sarah E Kerr; William A Cliby; Sean C Dowdy; Benjamin R Kipp; Andrea Mariani; Ann L Oberg; Karl C Podratz; Viji Shridhar; Mark E Sherman Journal: Gynecol Oncol Date: 2015-02-10 Impact factor: 5.482
Authors: Stephanie R DeJong; Jamie N Bakkum-Gamez; Amy C Clayton; Michael R Henry; Gary L Keeney; Jun Zhang; Trynda N Kroneman; Shannon K Laughlin-Tommaso; Lisa J Ahlberg; Ann L VanOosten; Amy L Weaver; Nicolas Wentzensen; Sarah E Kerr Journal: Cancer Med Date: 2021-09-16 Impact factor: 4.711
Authors: Ajleeta Sangtani; Chen Wang; Amy Weaver; Nicole L Hoppman; Sarah E Kerr; Alexej Abyzov; Viji Shridhar; Julie Staub; Jean-Pierre A Kocher; Jesse S Voss; Karl C Podratz; Nicolas Wentzensen; John B Kisiel; Mark E Sherman; Jamie N Bakkum-Gamez Journal: Gynecol Oncol Date: 2019-11-28 Impact factor: 5.482