Uterine Conservation at the Time of Pelvic Organ Prolapse Treatment: the Options for Patients and Providers

Surgical management of pelvic organ prolapse (POP) is a growing field. POP surgery has traditionally involved performing a hysterectomy at the time of repair for apical compartment prolapse. In recent years, providers and patients have called the medical necessity of this practice into question. There is growing evidence that uterine conservation may be a viable option during the time of prolapse repair. This article will review the historical perspective of uterine conservation, patient selection, conservative management, as well as surgical techniques and recent supporting literature of uterine-sparing procedures for POP. As women seek more minimally invasive approaches for prolapse repair, we anticipate that uterine conservation will continue to gain popularity.     

Health care costs and costs associated with changes in work productivity among persons with systemic lupus erythematosus

Objective

To estimate health care costs and costs associated with changes in work productivity among persons with systemic lupus erythematosus (SLE) in the US.

Methods

Data were derived from the University of California, San Francisco Lupus Outcomes Study. Participants provided information on their health care resource use and employment. Cost estimates were derived for both direct health care costs and costs related to changes in work productivity. Direct health care costs included costs for hospitalizations, emergency department services, physician visits, outpatient surgical procedures, dialysis, and medications. Productivity costs were estimated by measuring changes in hours of work productivity since diagnosis of SLE; these estimates were also compared with normal US population data.

Results

For the total population of participants, the mean annual direct cost was $12,643 (2004 US dollars). The mean annual productivity cost for subjects of employment age (≥18 and <65 years) was $8,659. The mean annual total cost (direct and productivity) for subjects of employment age was $20,924. Regression results showed that greater disease activity, longer disease duration, and worse physical and mental health were significant predictors of higher direct costs; older age predicted lower direct costs. Older age, greater disease activity, and worse physical and mental health status were significant predictors of higher costs due to changes in work productivity.

Conclusion

Both direct health care costs and costs associated with changes in work productivity are substantial and both represent important contributors to the total costs associated with SLE.