Economic and clinical benefits of radiofrequency ablation versus hysterectomy in patients suffering from menorrhagia: a retrospective analysis with German health claims data

Abstract

Objective: To assess clinical and economic benefits of radiofrequency ablation (RFA) compared to hysterectomy when treating patients suffering from menorrhagia. Methods: Based on German health claims data, a retrospective, longitudinal, observational analysis was performed. Patients having continuously statutory health insurance coverage during the study and being coded for menorrhagia and a relevant treatment option were included in the analysis. The control group was created using propensity score matching. Results: We discovered that using RFA generates cost savings of €1844 during the quarter of performance. As direct costs during a 2-year follow-up show similar levels in both groups, these initial savings can be preserved. This is partly because even if more patients in the RFA group were re-coded for menorrhagia after initial therapy, just a small proportion of these patients required another surgical intervention. Conclusion: RFA should more often be considered a relevant treatment option both from an economic and a medical point of view.

Keywords:

• costs
• Germany
• health claims data
• hysterectomy
• menorrhagia
• radiofrequency ablation

Acknowledgements

The authors would like to thank M Jochmann (Tagesklinik Hoyerswerda), G Kreuz (Tagesklinik Hoyerswerda), T Muscheid (Kplus Gruppe) and A Nugent (Tagesklinik Altonaer Straße) for excellent medical advice during the process of designing the study and analyzing the results. Further the authors are grateful to the Health Risk Institute GmbH for their cooperation and great support.

Financial & competing interests disclosure

This study was funded by Hologic Deutschland GmbH, manufacturer of the NovaSure^® endometrial ablation device. All authors have served as consultants to Hologic Deutschland GmbH. J Hucke, R Soeder and T Roemer received no consultancy fee for their role as advisors. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Transparency declaration

The lead author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; no important aspects of the study have been omitted.

Ethical approval

Due to secondary data and the study’s anonymous character, there was no need of informed consent or ethical approval.

Key issues

• Although being cost-intensive and, in many cases, not the only treatment option, the most common treatment in Germany for patients suffering from menorrhagia is hysterectomy.

• Losing the uterus is an emotional topic for women. However, several techniques, such as RFA, enable the reduction or stop of abnormal uterine bleeding while preserving the uterus.

• The analysis of German health claims data may help to understand healthcare reality and create new clinical and economic insights.

• As expected, more patients treated with RFA experience repeated diagnoses of menorrhagia after initial treatment compared to those treated with HE. However, only a small proportion of these patients are being re-treated due to menorrhagia during the follow-up period of 2 years.

• Treating menorrhagia with RFA generates savings of €1844 compared to HE during the quarter of performance, with hospital costs being the main cost driver for HE. As direct costs remain on a similar level during 2 years of follow-up, the initial savings can be preserved.

• Our findings are in line with results of previous research. However, so far, there is no comparable study targeting menorrhagia on the basis of German health claims data. Therefore, especially, our economic findings may be new to users and the whole affected society.