Uterine fibroids cost the U.S. billions each year in lost work days, pregnancy problems and treatments, a new study finds.

Uterine fibroids are common, non-cancerous growths that form from muscle cells and other tissue in the wall of the uterus. in the U.S., it’s estimated that up to 70 percent of white women develop fibroids at some point by age 50; among African-American women, that number is closer to 80 percent.

Often, fibroids cause no symptoms. but at least one-quarter of U.S. women have fibroid symptoms like heavy menstrual periods, bleeding between periods and abdominal or lower back pain.

And in some cases, fibroids can make it hard for a woman to get pregnant, or increase her risk of pregnancy complications like miscarriage and preterm birth.

Since fibroids are so common, “it’s very important to understand the societal costs,” said researcher Dr. James H. Segars of the U.S. National Institute of Child Health and Human Development in Bethesda, Maryland.

Based on his team’s estimates, uterine fibroids cost the U.S. anywhere from $6 billion to $34 billion each year. That’s with both treatment costs and “indirect” costs, like lost work days, taken into account.

In fact, Segars said, the cost of lost work — days off due to fibroid symptoms or to receive treatment — turned out to be the biggest expense. The researchers put that cost at anywhere from $1.5 billion to $17 billion annually.

Those cost ranges are very wide, Segars acknowledged. but, he said, they are estimates based on a collection of past studies that varied in how they collected data.

“That was the range in the literature,” Segars said. he added that, given how common fibroids are, he would guess that the actual costs are closer to the higher end of his team’s estimates.

“But it’s very difficult to get at the true cost,” Segars said.

The findings, reported in the American Journal of Obstetrics & Gynecology, are based on figures from recent studies and national databases.

The researchers estimate that the yearly cost of fibroid treatment in the U.S. ranges from about $4 billion to $9 billion.

Those treatment options include surgery, with hysterectomy (removal of the uterus) being most common. other women choose to have just the fibroids removed — a procedure called a myomectomy.

Other procedures include uterine artery embolization, where tiny particles are injected into blood vessels leading to the uterus, to cut off fibroids’ blood supply and shrink them; and endometrial ablation, which destroys the lining of the uterus.

Some women use medications — like painkillers and hormonal therapies — to manage heavy bleeding and painful periods. but they don’t get rid of the fibroids.

As for pregnancy complications linked to fibroids, Segars’ team put the yearly cost at anywhere from $238 million to close to $8 billion — again, a wide range.

Past studies, Segars said, have not considered pregnancy issues in estimating the cost of fibroids. he and his colleagues based their calculations on the prevalence of complications like miscarriage, preterm birth and cesarean section among U.S. women, plus estimates of how many pregnant women have fibroids.

It’s been estimated that anywhere from about 0.4 percent to 11 percent of pregnancies in the U.S. each year are to women with uterine fibroids.

Though precise dollar figures are hard to pin down, Segars said the bottom line is that uterine fibroids appear much more costly than has been appreciated.

And it’s particularly concerning, he noted, that 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.

“This most severely affects the population that’s least able to bear the costs,” Segars said.

That, he added, underscores the importance of finding ways to prevent fibroids.

No one is sure how to do that, however, because researchers don’t know exactly why fibroids form. Black women are at greater risk, as are women who are overweight or obese. on the other hand, women who’ve given birth seem to have a lower risk than those who’ve never had a baby.

Public release date: 22-Mar-2011 [ | E-mail | Share ] Contact: Simi Singersimi.singer@cshs.org310-435-9435Cedars-Sinai Medical Center

LOS ANGELES (March 22, 2011) when physical therapy and drugs fail to relieve back or neck pain, patients often turn to spinal fusion surgery as a last resort, but two new studies show that in certain situations, especially when several discs are involved, artificial disc replacement may give better long-term results at lower cost.

Hospital costs for artificial disc replacement were 49 percent lower, and four years out from surgery, artificial disc patients were four times less likely to need additional surgery than those who had fusion operations, according to two recently published studies.

“Back pain is the fifth leading cause of hospital admission and the third most common reason for surgery,” said orthopaedic surgeon Rick B. Delamarter, M.D., co-director of the Cedars-Sinai Spine Center. “Estimates vary and are probably understated, but health care expenditures for back pain top $91 billion a year, not including indirect and societal costs such as time lost from work and worker’s compensation.It is crucial that we develop surgical procedures that are cost effective without sacrificing high-quality results.”

Delamarter is a lead author of the two studies, which were published recently in the SAS Journal of the International Society for the Advancement of Spine Surgery and the Society for Minimally Invasive Spine Surgery.

Both studies compared disc replacement surgery with the more common fusion operation to treat degenerative disc disease ? deterioration caused by aging and wear and tear. One study looked at 209 patients with damaged neck discs who received either minimally invasive disc replacement or the more complex spinal fusion surgery. these patients were followed at regular intervals for four years. a separate group of 136 who received an artificial disc two years after the first group also were part of the study. All patients were assessed on their satisfaction with the results of the procedure. the other study focused on 53 patients suffering from three-level, lower back disc disease and looked at cost comparisons for length of hospital stay, resources used and other factors.

Discs act as cushions between the bones (vertebrae) of the spine. when healthy, the discs have enough “give” to allow the back to be flexible but are firm enough to provide stability. with age or injury, they lose their pliability and density. Nerves may become pinched between the bones, causing pain not just in the spine but in other parts of the body.

Fusion surgery seeks to relieve symptoms of the degenerative disease by removing the damaged disc and replacing it with bone. Studies show this procedure often can be effective but there can be drawbacks: in some cases, fused spinal sections can lose flexibility, impeding normal movement and stressing adjacent discs, often leading later to more fusion surgery. Artificial disc replacement, which has been performed in the United States since 2000, tends to cause less tissue injury than fusion surgery, and the discs are designed to maintain natural spine movement and reduce need for follow-up surgery.

In their study of patients suffering neck (cervical) disc disease, Delamarter and his colleagues found both disc replacement and fusion surgery acceptable options providing good long-term outcomes. But four years out from surgery, fusion patients were four times more likely to need more surgery. half of these secondary operations were needed to treat new disc problems occurring adjacent to fused sections.

Patients in the study had imaging scans to measure before-and-after flexibility and range of motion; were evaluated for physical and neurological improvement; and completed self-assessment questionnaires on neck disability, neck and arm pain intensity. Improvements were seen in all categories, regardless of the surgical procedure, but results tended to be at least slightly better in patients with disc replacements.

An important area, according to Delamarter, was patient satisfaction with the procedure. four years after surgery, nearly 88 percent of disc replacement patients reported that they were very to completely satisfied, compared with 76 percent of fusion patients. when asked if they would undergo the same surgery again, 89 percent of disc replacement patients and 81 percent of fusion patients said yes.

“While the results of this 13-center study are preliminary, it appears that artificial disc replacement surgery compares favorably as an effective procedure, is preferred by patients and slows the rate of adjacent-level disease,” Delamarter said.

Spinal fusion has been recognized as one of the more expensive surgical procedures. the second study looked at costs and is believed to be the first to compare those of three-level disc replacement with three-level fusion. It evaluated itemized billing records of 53 patients undergoing surgery for three consecutive discs of the low back (lumbar spine) at St. John’s Health Center in Santa Monica, Calif., where Delamarter practiced before joining Cedars-Sinai.

Total hospital costs for patients undergoing disc replacement surgery averaged 49 percent lower than those for fusion patients

The number of fusions for low back pain is rising rapidly, but Delamarter urges hospitals, insurers and surgeons to consider alternatives, including total disc replacement.

“After safety and effectiveness of a procedure have been documented, cost is an important consideration,” he said. “Artificial disc replacement technology appears to offer a promising, cost-saving alternative to fusion, especially for patients with disease at three levels.”

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Citation: SAS Journal, December 2010 “Results at 24 months from the prospective, randomized, multi-center Investigational Device Exemption trial of ProDisc-C versus anterior cervical discectomy and fusion with 4-year follow-up and continued access patients,” and “Cost comparison of patients with 3-level artificial total lumbar disc replacements versus 360-degree fusion at 3 contiguous lumbar vertebral levels: an analysis of compassionate use at 1 site of the US investigational device exemption clinical trial.”

The artificial discs implanted in these studies ? the ProDisc-C and ProDisc-L ? were manufactured by Synthes USA Products. Delamarter and his colleagues have evaluated outcomes and written about the devices since the FDA approved them for research and limited use in the United States. Delamarter is a consultant for Synthes and receives royalties on the ProDisc devices. However, he does not receive royalties on devices used for his patients or any other patients at Cedars-Sinai Medical Center.

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