Disparities persist in UFE access, utilization

Disparities persist across the U.S. in access to and use of uterine fibroid embolization (UFE) compared with hysterectomy and myomectomy, researchers have reported.

"[Our study found that] UFE was underutilized with significant disparities across socioeconomic factors," wrote a team led by Tarig Elhakim, MD, of the University of Pennsylvania in Philadelphia. The results were published September 16 in JAMA Network Open.

UFE is a minimally invasive alternative to surgery, and "understanding utilization patterns and disparities in access is important to ensure that patients can explore all treatment options," the researchers noted, writing that "compared with surgery, UFE is a shorter procedure, does not require general anesthesia, has faster recovery, has fewer complications, and costs less," and explaining that although "it can achieve a 42% reduction in fibroid size in three months with improvement of symptoms while potentially preserving fertility … [it] remains significantly less utilized than surgery."

The group examined trends in the use of UFE versus hysterectomy and myomectomy for uterine fibroid management -- with a focus on sociodemographic and institutional disparities -- via a study that included data from 271,885 uterine fibroid "encounters" taken from the National Inpatient Sample from the Healthcare Cost and Utilization Project between 2016 and 2022. The team identified patients with a uterine fibroid diagnosis who underwent hysterectomy, myomectomy, or UFE using codes from the International Statistical Classification of Diseases, Tenth Revision, Clinical Modification.

Of the total sample, there were 199,625 hysterectomies (73.4%), 62,675 myomectomies (23.1%), and 9,585 UFEs (3.5%). Median patient age for these three treatment types was 47, 37, and 45, respectively.

The race and ethnicity demographics of the study cohort were 105,780 (38.9%) African American, 16,175 (5.9%) Asian or Pacific Islander, 48,810 (18%) Hispanic, 1,050 (0.4%) Native American, 86,425 white (31.8%), and 13,645 (5%) other race.

The researchers reported the following:

• Increasing age was associated with lower odds of undergoing UFE versus hysterectomy, and higher odds of undergoing UFE versus myomectomy.
• African American patients were more likely to undergo UFE than hysterectomy (adjusted odds ratio [aOR], 1.64), but less likely to undergo UFE than myomectomy (aOR, 0.84).
• Hispanic patients were less likely to undergo UFE than both hysterectomy and myomectomy (aOR, 0.83).
• Patients with Medicaid, self-pay, and no-charge coverage had higher odds of undergoing UFE versus hysterectomy and myomectomy (aOR, 1.58, 1.97, and 1.97, respectively).
• UFE was more likely than myomectomy among Medicare patients aged 30 to 49, but less likely among those aged 50 and older.
• Those in the lowest income quartile had greater odds of undergoing UFE versus myomectomy (aOR, 1.22).
• Rural patients were less likely to undergo UFE than hysterectomy (aOR, 0.53), whereas urban hospitals were more likely to perform UFE than both surgical procedures (aOR, 7.13).

The study findings illuminate discrepancies in access and use of UFE, according to the group.

"Although utilization of UFE procedures has increased, they still lag far behind surgery," it concluded. "[Our] study encourages efforts to increase public awareness of UFE and improve its access equitably across the nation, ensuring that all patients receive fair, consistent, and high-quality care for uterine fibroids."

The complete study can be found here.