(27) Characterization and Treatment Pathways of Heavy Menstrual Bleeding (Champion-HMB): A Network Cohort Study

Publication Number: 701

Background: Heavy menstrual bleeding (HMB) affects an estimated 30% of women, impacting their health and quality of life. Despite the availability of non-invasive therapeutic options, including the levonorgestrel-releasing intrauterine device (LNG-IUS), up to 54% of women with HMB never receive a proper diagnosis or treatment. A delay in diagnosis may require more invasive treatment with fertility risk. Large real-world population-based studies on HMB are lacking.

Objectives: The Champion-HMB network study of real-world data aimed to describe the incidence rate and proportion of women diagnosed with HMB from 2000 to 2020, their baseline characteristics, longitudinal treatment pathways, and treatment guideline compliance in three countries with different healthcare systems.

Methods: This retrospective cohort study used 20 years of anonymized data standardized to the Observational Medical Outcomes Partnerships (OMOP) common data model (CDM) from four databases: electronic health records (EHR) from France (IQVIA LPD, primary care) and Germany (IQVIA DA, primary care and outpatient specialist), and claims from the USA (MarketScan, Optum). Seven cohorts were defined: (1) all women aged 11–55 years with continuous observation data of 365 days, and all women: (2) with an HMB diagnosis; (3) with HMB of unknown cause, (4) starting LNG-IUS treatment, (5) receiving, and (6) not receiving guideline-compliant treatment, and (7) with cervical cancer or endometrial hyperplasia or cancer. Patients were followed up until natural or medical menopause, hysterectomy, bilateral ovariectomy, age 55, or death.

Results: The descriptive analysis examined patient demographics, comorbidities, and underlying causes of HMB. HMB treatment pathways, LNG-IUS treatment duration and switching were also analyzed. Women receiving and not receiving first-line guideline-compliant treatment were identified and the frequency of surgical treatment (hysterectomy and endometrial ablation) was assessed. Of 55,974,084 eligible women, 3,049,915 (5.4%) with HMB were identified (39,565 in France, 118,885 in Germany and 2,629,643 in the USA).

Conclusions: Advanced network analytics allowed us to generate standardized, timely, real-world evidence into the patient journeys of women with HMB from diverse populations, countries, and datasets. The results show country-specific differences in HMB diagnosis, management, and variation in capture by setting (primary or specialist care, or hospital databases). The study will be expanded into further countries within the European Health Data & Evidence Network.