Comparative Uterine Cavity Dimensions on Hysterosalpingography (HSG) in Women with and without Fibroids: Implications for Fair Pricing Policies in Sub Saharan Africa

Abstract

Background: Hysterosalpingography (HSG) is a radiologic modality widely used for investigations in infertility evaluation and preoperative planning for gynecologic surgeries. It is relatively cheap, making it more affordable in low- and middle-income countries (LMICs), like in Sub-Saharan Africa. Uterine fibroids are highly prevalent among women undergoing HSG. Recent astronomical rise in the cost of iodinated contrast agents used in HSG has led some radiology centres to differentially increase the price of the procedure based on the presumption (with no empirical evidence) that fibroids cause uterine cavity enlargement, requiring the use of more volume of contrast. This has raised concerns on both equity and access to surgical capacity in LMICs. This study compared uterine cavity dimensions (length, width, volume) as seen on HSG between fibroid and non-fibroid subjects. Methodology: This is a prospective comparative study of women referred for HSG. Institutional ethical clearance and patients’ consent were duly obtained. Transabdominal ultrasound was performed to detect, characterize and measure fibroids. HSG was then used to demonstrate and measure the uterine cavity dimensions. The data was analysed with Statistical package for Social Sciences version 23. Simple descriptive statistics, independent sample t-test, and Pearson’s correlation tests were done. In all the significance tests, p-values ≤0.05 were considered statistically significant at 95% confidence interval. Results: A total of 185 were studied, consisting of 33 subjects (17.84%) in the fibroid subgroup and 152 subjects (82.16%) in the non-fibroid group. The mean uterine cavity dimensions were statistically greater among the fibroid group as follows: fibroid group vs non-fibroid groups; length [5.06cm vs 3.59cm (p˂0.001)], width [3.62cm vs 3.08cm (p=0.016)], volume [27.98cm3 vs 14.10cm3 (p˂0.001). Conclusion: The uterine cavity dimensions (length, width and volume) as measured on HSG of women with uterine fibroids are significantly larger than those without fibroids. However, fair pricing should also take into consideration equity, affordability and access.