Referrers frequently failing to recommend patients for key interventional radiology procedure
Patients often are overlooked for a key interventional radiology procedure, according to new data published Monday in JAMA Network Open.
Fibroids are the most prevalent benign tumor in women, potentially causing pelvic pain, urinary problems and infertility. Uterine fibroid embolization (UFE)—an image-guided procedure that stops blood flow to the uterus and relieves related symptoms—has been established as a safe, less invasive alternative to hysterectomy, experts note.
However, an analysis of nearly 272,000 uterine fibroid healthcare encounters, logged between 2016 and 2022, shows uneven access to the IR procedure. Uterine fibroid embolization was underutilized during this period (at about 4%) when compared to both hysterectomy (73%) and myomectomy (23%), a surgical procedure to remove these lumps from the uterus. Hysterectomy was more common among white, Hispanic and privately insured patients, the study found, while embolization was more frequently used for black patients, those with public insurance and from lower income communities.
“These findings suggest that there are substantial disparities in UFE utilization and highlight the need for targeted policies and referral strategies to promote equitable access to minimally invasive fibroid treatments,” Tarig S. Elhakim, MD, MPH, a hospitalist with Penn Medicine in Philadelphia, and co-authors wrote Sept. 16.
Researchers gathered their information from the Healthcare Cost and Utilization Project, a multicenter inpatient dataset representing hospitals across the U.S. Increasing patient age was associated with lower odds of undergoing embolization versus hysterectomy, the authors noted. Patients with Medicaid, self-pay and no-charge coverage, meanwhile, had higher odds of undergoing embolization than surgery. Elhakim and colleagues noted the lower cost of the IR procedure may explain its greater prevalence in economically challenged patient populations.
Conversely, privately insured individuals, who represented the highest percentage uterine fibroid cases, had greater utilization of surgical interventions, the study found.
“This may reflect disparities in access associated with financial and institutional incentives, as well as referral networks, since gynecologists have to refer patients to [interventional radiologists] for [uterine fibroid embolization] consultation or keep them for myomectomy or hysterectomy,” Elhakim et al. wrote. “In contrast, Medicare demonstrated a distinct pattern in UFE utilization.”
Among patients ages 30 to 49, who typically qualify for Medicare because of disability, UFE was performed more frequently. This was likely because younger Medicare recipients often have disabling, comorbid conditions that may make a less-invasive option such as embolization safer than surgery However, among patients 50 and up, UFE was less utilized than myomectomy, despite this older group typically having higher comorbidities.
Elhakim and colleagues highlighted previous research, showing potential reasons for low utilization of the IR procedure. There are limited and conflicting data about fertility outcomes after the embolization. Plus, a lack of awareness among gynecologists about the benefits and risks may lead to recommendations for surgery.
“Collaboration between gynecologists and IRs may increase UFE utilization, as supported by a study featuring a multidisciplinary fibroid clinic in an urban healthcare system that included IRs and gynecologists,” the authors noted. “Standardizing IR protocols for UFE and fostering multidisciplinary collaboration and communication with gynecologists are essential strategies to improve early referrals and broaden the pool of patients considered for UFE,” they added later.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.