Economic and clinical benefits of endometrial radiofrequency ablation compared with other ablation techniques in women with menorrhagia: a retrospective analysis with German health claims data

Abstract

ObjectiveTo evaluate the economic and clinical benefits of endometrial radiofrequency ablation (RFA) compared with other ablation techniques for the treatment of menorrhagia.MethodsUsing German health claims data, women meeting defined inclusion criteria for the intervention group (RFA) were selected. A comparable control group (other endometrial ablations) was established using propensity score matching. These two groups were compared during the quarter of treatment (QoT) and a follow-up of 2 years for the following outcomes: costs during QoT and during follow-up, repeated menorrhagia diagnoses during follow-up and necessary retreatments during follow-up.ResultsAfter performing propensity score matching, 50 cases could be allocated to the intervention group, while 38 were identified as control cases. Patients in the RFA group had 5% fewer repeat menorrhagia diagnoses (40% vs 45%; not significant) and 5% fewer treatments associated with recurrent menorrhagia (6% vs 11%; not significant) than cases in the control group. During the QoT, the RFA group incurred €578 additional costs (€2,068 vs €1,490; ns). However, during follow-up, the control group incurred €1,254 additional costs (€4,561 vs €5,815; ns), with medication, outpatient physician consultations, and hospitals costs being the main cost drivers. However, none of the results were statistically significant.ConclusionAlthough RFA was more cost-intensive in the QoT compared with other endometrial ablation techniques, an average total savings of €676 was generated during the follow-up period. While having evidence that RFA is clinically equivalent to other endometrial ablation procedures, we generated indications that RFA is non-inferior and favorable with regard to economic outcomes.

Health economic evaluations based on routine data in Germany: a systematic review

“…Figure 2 shows that 21 studies (60.0%) evaluated health care programs such as disease management programs which were assessed in 8 studies (22.9%) alone [ 21 , 25 – 27 , 37 , 39 , 43 , 49 ]. Evaluations were also performed on pharmaceuticals in 8 studies (22.8%) [ 30 , 35 , 41 , 44 – 48 ] and medical products or procedures in 6 studies (17.1%) [ 2 , 3 , 23 , 24 , 36 , 50 ]. Funding can mainly be ascribed to industry ( n = 15, 42.9%) – generally the involved health insurance fund or product manufacturer – or public sources ( n = 8, 22.9%).…”

“…Of the remaining studies, 4 (11.4%) used claims data from several different health insurance funds – 2 of which (5.7%) specified which funds were involved [ 45 , 46 ]. The other two studies (5.7%) referred to a SHI database [ 24 , 36 ]. Finally, two studies (5.7%) did not specify which individual fund supplied the data [ 34 , 37 ].…”

Risk of Hysterectomy After Endometrial Ablation

“…Figure 1 represents the flowchart of the article selection process. Among the 53 included articles, six were retrospective cohort studies, 14–19 23 prospective cohort studies, 20–42 and 24 RCTs 4,43–65 (Table 1). Twenty-four studies reported data only at 12 months of follow-up, and 29 studies published data between 12 and 120 months of follow-up.…”

Endometrial ablation plus levonorgestrel releasing intrauterine system versus endometrial ablation alone in women with heavy menstrual bleeding: study protocol of a multicentre randomised controlled trial; MIRA2 trial

“…Based on a literature search of previous studies on hysterectomy rate after EA, we found variation in hysterectomy rates between 9 and 17.5% [ 3 , 23 – 26 ]. An assessment in the Dutch population of hysterectomy rates after EA indicates a hysterectomy rate around 15% after previous EA in daily practice.…”