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Evaluation of reasons for endometrial ablation failures
Oral Presentations
such as IVP, CT-scan or ultrasound, 2) The cystoscopy increases the surgeon and patient confidence in the integrity of the urinary tract during the recovery period. Corzclusiorz. Cystoscopy at the end of surgery for TLH/ STLH is as important as hemostasis evaluation. It allows immediate diagnosis and repair of damage to the ureter should it occur. In cases of Urinary complaints in post-op patients, cystoscopy prevents the need for further invasive and expensive tests.
Plenary 11--Global Ablation II 93. Economic Impact of HydroThermAblator (HTA) Endometrial Ablation versus Hysterectomy for Dysfunctional Uterine Bleeding (DU B) 1JM Berman, 2Bj Justason, 2S Reid, 3MA Clark. 1University Women's Care, Southfield, Massachusetts. 2Boston Scientific Corporation, Natick, Massachusetts. 3University of Birmingham, West Midlands, United Kingdom.
Objective. To compare payer costs and the potential economic impact to a health plan of HTA vs. hysterectomy treatment for DUB. Desigrz. Two-year treatment costs were modeled using decision analytic techniques incorporating HTA clinical trial outcomes and estimated payer costs. All costs reflect 2003 US dollars. Settirzg. Typical 1 million member US private payer health plan. Patierzts. Women with DUB. Irzterverztiorzs. HTA endometrial ablation and hysterectomy. Measuremerzts arzd Mairz Results. At 2 years, 93 % of HTA patients required no further treatments. Total payer medical costs for HTA patients averaged $3,611 per patient at 2 years. The average total cost for hysterectomy patients was $8,627. Compared to hysterectomy, HTA resulted in costsavings of $5,016 over a 2-year follow-up period. In a health care plan covering 1 million members with an incidence rate of DUB treatment = 52.9/100,000--conversion of 25% and 50% of hysterectomy cases to HTA may result in 2-year cost savings of $663,366 and $1,326,732, respectively, for a cohort of women with DUB. Conclusion. From a payer perspective, HTA appears to be a reasonable and potentially cost-saving alternative to hysterectomy for treatment of DUB patients.
94. Evaluation of Reasonsfor Endometrial Ablation Failures PG Brooks. Cedars-Sinai Medical Center, Los Angeles, California.
Objective. To assess the reasons why patients with successful outcomes at 12 months post endometrial ablation subsequently had repeat ablation procedures, hysterectomy or other interventions within 36 months of initial treatment. Desigrz. Analysis of data from the randomized multi-center Phase III clinical trial of the HTA vs. rollerball (RB).
Settirzg. Nine university and private practice centers in the United States. Irzterverztiorzs. Hysteroscopic endometrial ablation treatments per protocol with HTA (n = 177) and RB (n = 77). Measummerzts arzdMairz Results. Bleeding assessment was by means of pictorial diaries at 12 months, and by patient interviews at 24 and 36 months. Reduction of bleeding to normal levels or less, amenorrhea rates, patient satisfaction and re-treatment, hysterectomy or other interventions were tracked for 36 months. Of the patients with successful treatment outcomes reported at 12 months, 20 subsequently had hysterectomies, 6 had repeat endometrial ablations, and 2 had uterine artery embolization for fibroids. Reasons included persistent pain, menorrhagia, benign pelvic mass and endometriosis. Corzclusiorz. While hysteroscopic endometrial ablation is successful in reducing bleeding to normal levels or less for the vast majority of appropriately selected patients, these patients should be advised that further treatment or even hysterectomy may be necessary in the future.
95. The HydroThermAblator System (HTA) for the Management of Menorrhagia in Women With Submucous Myomas: Twelve to Twenty Month Follow-up MH Glasser. Kaiser Permanente, San Rafael, California.
Objective. To assess the safety and efficacy of using the Hydro ThermAblator system (HTA) to treat patients with menorrhagia and submucous myomas up to 4 cm. in diameter by the circulation of free flowing heated (90E C) saline. Desigrz. Retrospective multicenter cohort study (Canadian Task Force classification II-2). Settirzg. Two medical centers from a large prepaid multispecialty Health Maintenance Organization. Patierzts. Twenty-two patients with submucous myomas of 54 patients treated with the Hydro ThermAblator system for menorrhagia from July, 2001 through March, 2002. Treatment with the Hydro ThermAblator system (HTA) which circulates free flowing, heated (90E C) saline in the uterine cavity for ten minutes under direct hysteroscopic control. Measuremerzts arzd Mairz Results. All patients with submucous myomas treated with the Hydro ThermAblator system who were at least on year post treatment were contacted regarding their menstrual history. Success was defined as no further medical or surgical intervention following Hydro ThermAblation. The average time of follow-up was 15.4 months with a range of 12-20 months. The average age of the patients was 47.5 years with a range of 34-60 years of age. Twelve of 22 patients (54%) reported complete an~enorrhea. Five of 22 (23 %) reported oligomenorrhea and 3 of 22 (14%) reported eumenorrhea and were very satisfied with that result. The overall success rate was 91%. There were 2 failures. Corzclusiorz. Hydro ThermAblation (HTA) using free flowing, heated (90E C) saline is a safe and effective treatment
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such as IVP, CT-scan or ultrasound, 2) The cystoscopy increases the surgeon and patient confidence in the integrity of the urinary tract during the recovery period. Corzclusiorz. Cystoscopy at the end of surgery for TLH/ STLH is as important as hemostasis evaluation. It allows immediate diagnosis and repair of damage to the ureter should it occur. In cases of Urinary complaints in post-op patients, cystoscopy prevents the need for further invasive and expensive tests.
Plenary 11--Global Ablation II 93. Economic Impact of HydroThermAblator (HTA) Endometrial Ablation versus Hysterectomy for Dysfunctional Uterine Bleeding (DU B) 1JM Berman, 2Bj Justason, 2S Reid, 3MA Clark. 1University Women's Care, Southfield, Massachusetts. 2Boston Scientific Corporation, Natick, Massachusetts. 3University of Birmingham, West Midlands, United Kingdom.
Objective. To compare payer costs and the potential economic impact to a health plan of HTA vs. hysterectomy treatment for DUB. Desigrz. Two-year treatment costs were modeled using decision analytic techniques incorporating HTA clinical trial outcomes and estimated payer costs. All costs reflect 2003 US dollars. Settirzg. Typical 1 million member US private payer health plan. Patierzts. Women with DUB. Irzterverztiorzs. HTA endometrial ablation and hysterectomy. Measuremerzts arzd Mairz Results. At 2 years, 93 % of HTA patients required no further treatments. Total payer medical costs for HTA patients averaged $3,611 per patient at 2 years. The average total cost for hysterectomy patients was $8,627. Compared to hysterectomy, HTA resulted in costsavings of $5,016 over a 2-year follow-up period. In a health care plan covering 1 million members with an incidence rate of DUB treatment = 52.9/100,000--conversion of 25% and 50% of hysterectomy cases to HTA may result in 2-year cost savings of $663,366 and $1,326,732, respectively, for a cohort of women with DUB. Conclusion. From a payer perspective, HTA appears to be a reasonable and potentially cost-saving alternative to hysterectomy for treatment of DUB patients.
94. Evaluation of Reasonsfor Endometrial Ablation Failures PG Brooks. Cedars-Sinai Medical Center, Los Angeles, California.
Objective. To assess the reasons why patients with successful outcomes at 12 months post endometrial ablation subsequently had repeat ablation procedures, hysterectomy or other interventions within 36 months of initial treatment. Desigrz. Analysis of data from the randomized multi-center Phase III clinical trial of the HTA vs. rollerball (RB).
Settirzg. Nine university and private practice centers in the United States. Irzterverztiorzs. Hysteroscopic endometrial ablation treatments per protocol with HTA (n = 177) and RB (n = 77). Measummerzts arzdMairz Results. Bleeding assessment was by means of pictorial diaries at 12 months, and by patient interviews at 24 and 36 months. Reduction of bleeding to normal levels or less, amenorrhea rates, patient satisfaction and re-treatment, hysterectomy or other interventions were tracked for 36 months. Of the patients with successful treatment outcomes reported at 12 months, 20 subsequently had hysterectomies, 6 had repeat endometrial ablations, and 2 had uterine artery embolization for fibroids. Reasons included persistent pain, menorrhagia, benign pelvic mass and endometriosis. Corzclusiorz. While hysteroscopic endometrial ablation is successful in reducing bleeding to normal levels or less for the vast majority of appropriately selected patients, these patients should be advised that further treatment or even hysterectomy may be necessary in the future.
95. The HydroThermAblator System (HTA) for the Management of Menorrhagia in Women With Submucous Myomas: Twelve to Twenty Month Follow-up MH Glasser. Kaiser Permanente, San Rafael, California.
Objective. To assess the safety and efficacy of using the Hydro ThermAblator system (HTA) to treat patients with menorrhagia and submucous myomas up to 4 cm. in diameter by the circulation of free flowing heated (90E C) saline. Desigrz. Retrospective multicenter cohort study (Canadian Task Force classification II-2). Settirzg. Two medical centers from a large prepaid multispecialty Health Maintenance Organization. Patierzts. Twenty-two patients with submucous myomas of 54 patients treated with the Hydro ThermAblator system for menorrhagia from July, 2001 through March, 2002. Treatment with the Hydro ThermAblator system (HTA) which circulates free flowing, heated (90E C) saline in the uterine cavity for ten minutes under direct hysteroscopic control. Measuremerzts arzd Mairz Results. All patients with submucous myomas treated with the Hydro ThermAblator system who were at least on year post treatment were contacted regarding their menstrual history. Success was defined as no further medical or surgical intervention following Hydro ThermAblation. The average time of follow-up was 15.4 months with a range of 12-20 months. The average age of the patients was 47.5 years with a range of 34-60 years of age. Twelve of 22 patients (54%) reported complete an~enorrhea. Five of 22 (23 %) reported oligomenorrhea and 3 of 22 (14%) reported eumenorrhea and were very satisfied with that result. The overall success rate was 91%. There were 2 failures. Corzclusiorz. Hydro ThermAblation (HTA) using free flowing, heated (90E C) saline is a safe and effective treatment
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