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Annual impact of uterine fibroids: billions

Robin Wulffson MD's picture
uterine fibroids, fibroid tumors, leiomyomas, hysterectomy, myomectomy, costs

Uterine fibroids (leiomyomas) are the most common pelvic tumor. One in five women may have fibroids during their childbearing years (the time after starting menstruation for the first time and before menopause). Their incidence is higher among African American women than Caucasian women. Many women with fibroids experience some experience pain, heavy menses, or bleeding between periods. They also can cause fertility problems or pregnancy complications such as miscarriage or premature birth.

According to a new study, uterine fibroids cost the U.S. billions each year in lost work days and pregnancy complications. Dr. James H. Segars of the U.S. National Institute of Child Health and Human Development in Bethesda, Maryland and his research team set out to estimate the total annual societal cost of uterine fibroids in the United States, based on direct and indirect costs, including associated obstetric complications. Their findings were published online on December 12 in the American Journal of Obstetrics & Gynecology. Since fibroids are so common, "it's very important to understand the societal costs," noted Dr. Segar.

The researchers estimated that uterine fibroids cost the U.S. from $6 billion to $34 billion each year. That amount includes both treatment costs and "indirect" costs such as lost work days. In regard to lost work, Dr. Segars noted that days off due to fibroid symptoms or to receive treatment were found to be the largest costs. The investigators estimated that cost between $1.5 billion to $17 billion annually. Dr. Segars acknowledged that the cost spread was quite wide; however, he explained that they were derived from estimates reported in a number of past studies, which varied in their data collection methods. He noted, "That was the range in the literature." He added that, given how common fibroids are, he assumes that the actual costs are closer to the higher end of his team's estimates.

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The authors estimated that the annual cost of uterine fibroid treatment in the United States ranges from about $4 billion to $9 billion. The most common treatment option is a hysterectomy. For women who want to preserve their childbearing or are opposed to a hysterectomy, a myomectomy can be performed: the growths are surgically removed and the uterus is repaired. In recent years, this procedure has been done more frequently with laparoscopic surgery. Hysterectomies can also be done via the laparoscope.

The researchers placed the annual cost of pregnancy complications related to fibroids from $238 million to almost $8 billion. Dr. Segars noted that past researchers did not factor in pregnancy complications when estimating costs. Estimates of the presence of fibroids range from 0.4% to 11% of pregnancies in U.S. women each year.

Despite the wide range of cost estimates, Dr. Segars noted that the bottom line is that uterine fibroids appear much more costly than has been appreciated. He noted, that since fibroids are more common and more severe in African-American women, who may find it harder to bear the burden of lost wages and other costs. He explained, "This most severely affects the population that's least able to bear the costs,”

Currently, the reason that uterine fibroids is unknown; thus, no preventive measures exist. Ethnicity and obesity are known factors. Obesity increases the risk and bearing one or more children decreases the risk.