Abstract

*Olúgbémiga T. Ekúndayò, MD, MPH, DrPH and Marquisette Glass Lewis, MS, MPH, PhD

ABSTRACT

Uterine gynecological procedure cost differences are important components of considerations for affordability, care access and quality. To achieve affordability, equity, and inclusion, reducing disparities, care distribution and cost correlates are important considerations for decision-making. This study determines and compares the distribution, cost and correlates, of Uterine Artery Embolization and classical Abdominal Hysterectomy by region, race, payor, complications, length of stay, and referral source. Study Design: The 2004 -2008 National Hospital Discharge data sets for Hysterecstomy and Uterine Artery Embolization were trimmed and categorized. Crosstabs determined cost distributions by region, place/location, age, race, income, education, length of stay, and payor. Multinomial Logistic Regression analyses determined correlates for all stratified factors. Results: Relationships between race, payor, length of stay, region, income, and care cost showed different regional patterns. All regions were less likely than the West to be more expensive. African Americans were more likely to pay below $20,000.00. White and Hispanic women were more likely to be on private, HMO or self-pay. One hospital day’s stay cost less than three or more days, Emergency room referrals were less likely to pay below $30,000.00. For hysterectomy, minor complications were more likely to cost below $20,000.00. UAE cost more than Hysterectomy (mean difference: $4,223.52). Conclusion: With significant disparity between regions, especially at low cost levels, and race, further research needs to determine cost correlates background/context for affordability, material hardship, multi-sectorial policy, workforce development, and other social determinants. A clear epidemiological picture of uterine fibroids, through appropriately vigilant surveillance, is needed.