Health care resource use for uterine fibroid tumors in the United States Michael Flynn, MD, MHS, a Margaret Jamison, PhD, b Santanu Datta, PhD, MBA, c,d Evan Myers, MD, MPH b Division of Gynecological Specialties, Department of Obstetrics and Gynecology, a Division of Clinical and Epidemiological Research, Department of Obstetrics and Gynecology, b and Department of Medicine, Division of General Internal Medicine, c Duke University Medical Center; Health Services Research and Development, Durham Veterans Administration Medical Center, d Durham, NC Received for publication October 18, 2005; revised January 31, 2006; accepted February 12, 2006 KEY WORDS Leiomyoma Cost Objective: The purpose of this study was to quantify the total direct cost to the US health care system for the management of uterine leiomyomas. Study design: We used Center for Disease Control heath care databases for estimates of inpatient care, ambulatory care, and outpatient care of leiomyomas. With International Classification of Diseases–9 codes for fibroid tumors and fibroid-related conditions, all fibroid-related care was identified in each database. Inpatient and ambulatory surgical cases were stratified by surgical procedure, and outpatient clinical cases were categorized by type of visit and health care provider. With the use of Medicare’s RBRVU reimbursement rates for 2000 as a proxy for the cost of phy- sician services and Medicare diagnostic-related group reimbursement as a proxy for facility costs, the total direct cost to the US health care system for the care of fibroid tumors was estimated. Results: Total direct cost to treat uterine fibroid tumors was estimated at $2,151,484,847. Most of the cost was due to inpatient care, in particular, hysterectomy. Conclusion: Uterine fibroid tumors consume a significant amount of health care resources in the United States. Ó 2006 Mosby, Inc. All rights reserved. With prevalence up to 70% in reproductive-aged women, uterine leiomyoma (or fibroid tumors) remain one of the most common gynecologic conditions in the United States. 1 Although most fibroid tumors cause min- imal or no symptoms, up to one third of them may cause symptoms such as abnormal bleeding or pain that require medical intervention. 1 The cumulative incidence of self-reported leiomyomas among 15- to 42-year-old women in the Nurse’s Health Study was 22.5%, with approximately 65% of these women reporting symp- toms. 2 Symptomatic uterine leiomyoma remain the most cited indication for hysterectomy, which is one of the most common surgical procedures performed in the United States. 2-4 It is also well-established that uterine fi- broid tumors are significantly more prevalent and more symptomatic and appear at a younger age in black women than in white women. 2,5,6 With the prevalence Reprints not available from the authors. Address correspondence to Michael K. Flynn, MD, MHS, 601 Elmwood Avenue, Box 668, Rochester NY, 14642. E-mail: michaelk_flynn@urmc.rochester.edu 0002-9378/$ - see front matter Ó 2006 Mosby, Inc. All rights reserved. doi:10.1016/j.ajog.2006.02.020 American Journal of Obstetrics and Gynecology (2006) 195, 955–64 www.ajog.org