Describing the Patient Journey of Women with Claims for Uterine Fibroids and Heavy Menstrual Bleeding Using a Commercial Database (2011–2020)

Figures & data

Table 1 Patient Attrition

Cohort Selection Criteria	N Remaining	n (%) Excluded
≥2 outpatient claims ≥30 days apart or 1 inpatient claim with UF diagnosis	299,416	0 (0.0)
≥1 medical claim with a diagnosis of HMB at any time during the study period	176,471	122,945 (41.1)
≥18 years and <56 years of age as of index date	163,697	12,774 (4.3)
Female sex	163,520	177 (0.1)
≥12 months of continuous enrollment prior to index date	98,708	64,812 (21.6)
≥12 months of continuous enrollment during follow-up^a	85,852	12,856 (4.3)
No evidence of hysterectomy during pre-index period	85,428	424 (0.1)
Total patients in UF-HMB cohort	85,428

Notes: ^aOr until the date of a hysterectomy (for patients who underwent this procedure <12 months following the index date).

Abbreviations: HMB, heavy menstrual bleeding; UF, uterine fibroids.

Table 2 Patient Demographic and Clinical Characteristics at Index

Characteristic	N=85,428
Age at index, mean (SD)	43.7 (6.4)
Age group at index, n (%)
18–29 years	1867 (2.2)
30–44 years	41,258 (48.3)
45–55 years	42,303 (49.5)
Race, n (%)
White	46,139 (54.0)
African American	17,297 (20.2)
Other^a	18,495 (21.6)
Missing	3497 (4.1)
Region, n (%)
Northeast	10,673 (12.5)
Midwest	16,866 (19.7)
South	40,321 (47.2)
West	17,229 (20.2)
Unknown	339 (0.4)
Payer type, n (%)
Commercial	83,173 (97.4)
Medicare	2255 (2.6)
Health plan type, n (%)
EPO	10,697 (12.5)
HMO	11,524 (13.5)
POS	59,723 (69.9)
PPO	2530 (3.0)
Other	937 (1.1)
Indemnity	17 (0.02)
HMB diagnosis relative to index (UF diagnosis), n (%)
≤6 months prior to UF diagnosis (not inclusive of index)	28,164 (33.0)
>6-12 months prior to UF diagnosis	7221 (8.5)
>12 months prior to UF diagnosis	19,704 (23.1)
0–3 months after UF diagnosis (inclusive of index)	14,553 (17.0)
>3 and ≤6 months after UF diagnosis	2655 (3.1)
>6 months after UF diagnosis	13,131 (15.4)
CCI score at index, n (%)
0	65,096 (76.2)
1	13,391 (15.7)
2	4144 (4.9)
3+	2797 (3.3)
Comorbidities or conditions related to women’s health in the pre-index period, n (%)
Endometriosis	4324 (5.1)
Pregnancy (at any time during the pre-index period)	4143 (4.8)
Uterine polyps	3643 (4.3)
Infertility	2294 (2.7)
Adenomyosis	941 (1.1)
Uterine rupture	2 (0.0)
Bulk symptoms, prevalence in the pre-index period, n (%)
0	42,825 (50.1%)
1	26,738 (31.3%)
2	11,092 (12.9%)
≥3	4773 (5.6%)
Bulk symptoms in the pre-index period, type, n (%)
Pelvic pressure/pain	23,570 (27.6)
Backache	14,950 (17.5)
Urinary frequency/incontinence	8488 (9.9)
Leg pain	8260 (9.7)
Constipation	3794 (4.4)
Increased abdominal girth	3414 (4.0)
Abdominal distention	2069 (2.4)
Other comorbidities in the pre-index period, n (%)
Hypertension	18,059 (21.1)
Hyperlipidemia	16,415 (19.2)
Fatigue	15,325 (17.9)
Urinary tract infection	11,777 (13.8)
Obesity	11,398 (13.3)
Anxiety	10,841 (12.7)
Depression	9014 (10.6)
Chronic pulmonary disease	8414 (9.8)
Diabetes	6828 (8.0)
Nausea/vomiting	6405 (7.5)
Constipation	3794 (4.4)
Anemia	3734 (4.4)
Diarrhea	3508 (4.1)

Note: ^aIncludes Asian and other races.

Abbreviations: CCI, Charlson comorbidity Index; EPO, exclusive provider organization; HMB, heavy menstrual bleeding; HMO, Health maintenance organization; POS, point of service, PPO, preferred provider organization; UF, uterine fibroids.

Figure 1 Patient Treatment Patterns Through 24 Months.

Abbreviation: UF, uterine fibroid.

Figure 2 UF-related Pharmacotherapy Use Before and After Initial UF Diagnosis.

Abbreviations: GnRH, gonadotropin-releasing hormone; NSAID, non-steroidal anti-inflammatory drug; UF, uterine fibroid.

Table 3 Mean Time (Days) on Post-Index Contraceptive Hormone Therapy

Patients on Post-Index Contraceptive Hormones Who had ≥24 Months of Follow-Up
n	19,908
Percent of total cohort (N=85,428)	23.3
Mean duration of contraceptive hormone use, days	284
Patients who discontinued 1st or 2nd contraceptive hormone
n	17,918
Percent of total cohort (N=85,428)	21.0
Percent of contraceptive hormone cohort (n=19,908)	90.0
Patients who discontinued contraceptive hormone use after 1 agent
n	16,024
Percent of total cohort (N=85,428)	18.8
Percent of contraceptive hormone cohort (n=19,908)	80.5
Mean duration of treatment, days	209
Patients who discontinued contraceptive hormone use after 2 agents
n	1894
Percent of total cohort (N=85,428)	2.2
Percent of contraceptive hormone cohort (n=19,908)	9.5
Mean duration of treatment, days	472

Table 4 Subsequent Therapies Received by Patients Who Discontinued Initial Post-Index Contraceptive Hormones

Patients with ≥24 Months of Follow-Up who Discontinued their initial Post-Index Contraceptive Hormone Therapy	Patients (N=16,024) n (%)
Non-contraceptive steroid hormones	2641 (16.5)
Re-start contraceptive hormones	4965 (31.0)
Hysterectomy	3438 (21.5)
Oophorectomy	651 (4.1)
Myomectomy	984 (6.1)
UF embolization	204 (1.3)
Endometrial ablation	684 (4.3)
MRI-guided focused ultrasound surgery	1 (0.01)
Radiofrequency ablation (laparoscopic or transcervical)	1 (0.01)
Laparoscopic	1 (0.01)
Transcervical	0
Other^a	2454 (15.3)

Note: ^aPain medication, anti-depressants, etc.

Abbreviations: MRI, magnetic resonance imaging; UF, uterine fibroid.

Figure 3 KM Analysis of Time to Hysterectomy.

Notes: Start of analysis is the study index date for all patients, pts with prior procedures, and pts without prior procedures. Pts with prior procedures = subgroup of patients who had a pre-index surgical procedure; Pts without prior procedures = subgroup of patients who did not have a pre-index surgical procedure.

Abbreviation: pt, patient.

Figure 4 Forest Plot of Multivariate Cox Proportional Hazards Model, Time to (A) Initiation of Hormonal Therapy and (B) Hysterectomy. *Measured during 6-month intervals post-UF diagnosis.

Notes: For time to initiation of hormone therapy, 66,656 patients were included in the final model; 18,772 were excluded because they had prior hormone therapy before the UF diagnosis date. References: Age, 18–29 years; Race, White; Geographic region, Northeast; CCI, 0; Comorbidities, absence of each respective comorbidity; Bulk symptoms, absence of each respective bulk symptom.

Abbreviations: CCI, Charlson Comorbidity Index; CI, confidence interval; HR, hazard ratio.