Real-World Evaluation of Direct and Indirect Economic Burden Among Endometriosis Patients in the United States

Abstract

IntroductionThe prevalence of endometriosis and the need for treatment in the USA has led to the need to explore the contemporary cost burden associated with the disease. This retrospective cohort study compared direct and indirect healthcare costs in patients with endometriosis to a control group without endometriosis.MethodsWomen aged 18–49 years with endometriosis (date of initial diagnosis = index date) were identified in the Truven Health MarketScan® Commercial database between 2010 and 2014 and female control patients without endometriosis were matched by age and index year. The following outcomes were compared: healthcare resource utilization (HRU) during the 12-month pre- and post-index periods (including inpatient admissions, pharmacy claims, emergency room visits, physician office visits, and obstetrics/gynecology visits), annual direct (medical and pharmacy) and indirect (absenteeism, short-term disability, and long-term disability) healthcare costs during the 12-month post-index period (in 2014 US$). Multivariate analyses were conducted to estimate annual total direct and indirect costs, controlling for demographics, pre-index clinical characteristics, and pre-index healthcare costs.ResultsOverall, 113,506 endometriosis patients and 927,599 controls were included. Endometriosis patients had significantly higher HRU during both the pre- and post-index periods compared to controls (p < 0.0001, all categories of HRU). Approximately two-thirds of endometriosis patients underwent an endometriosis-related surgical procedure (including laparotomy, laparoscopy, hysterectomy, oophorectomy, and other excision/ablation procedures) in the first 12 months post-index. Mean annual total adjusted direct costs per endometriosis patient during the 12-month post-index period was over three times higher than that for a non-endometriosis control [$16,573 (standard deviation (SD) = $21,336) vs. $4733 (SD = $14,833); p < 0.005]. On average, incremental direct and indirect 12-month costs per endometriosis patient were $10,002 and $2132 compared to their matched controls (p < 0.005).ConclusionsEndometriosis patients incurred significantly higher direct and indirect healthcare costs than non-endometriosis patients.FundingAbbVie Inc.Electronic supplementary materialThe online version of this article (10.1007/s12325-018-0667-3) contains supplementary material, which is available to authorized users.

Impact of Endometriosis Diagnostic Delays on Healthcare Resource Utilization and Costs

“…Patients had an average of 11.7 all-cause annualized ambulatory visits, 0.8 all-cause annualized emergency visits, and 0.1 all-cause annualized inpatient stay during the 60-month pre-diagnosis period. Similarly, Soliman et al [17] reported that patients with endometriosis averaged 9.9 office/obstetrics-gynecology visits, 0.6 emergency visits, and 0.1 inpatient admissions in the 12 months prior to diagnosis. Utilization of healthcare services was also comparable to results described by Fuldeore et al [18] who found emergency visits, outpatient visits, and physician visits increased over a 5-year period prior to endometriosis diagnosis peaking in the year immediately prior to diagnosis.…”

“…Patients with endometriosis experience significant healthcare expenses. In a study of endometriosis patients and matched controls, mean annual adjusted direct healthcare costs were more than three times higher in endometriosis patients than controls during the 12 months following diagnosis ($16,573 versus $4733, p \ 0.005) [17]. Fuldeore et al found that costs were highest in the first year following an endometriosis diagnosis, costing $13,199 compared with $6041 in the year prior to diagnosis and $6720 in the year following the index year.…”

A Longitudinal Assessment of the Impact of Endometriosis on Patients’ Salary Growth and Risk of Leaving the Workforce

“…In addition to potentially painful symptoms and significant healthcare costs [7,8], endometriosis is associated with increased work absenteeism and decreased productivity [9]. A Danish survey study compared 610 employed patients with endometriosis with 751 control patients and reported that those with endometriosis had significantly more sick days, work disturbance due to symptoms, and lower work ability (attributed to pain and tiredness) [10].…”

Preliminary insights on the relation between endometriosis, pelvic pain, and employment

“…In a retrospective cohort study, Soliman et al [15] found that women with endometriosis had significantly higher direct healthcare costs, as well as indirect costs due to work loss through absenteeism and short-or long-term disability relative to control participants without a history of endometriosis. As underlined by Hummelshoj [16], treatment costs account for only one third of the total annual economic burden of endometriosis (estimated at EUR 9579 per woman [11]) because two thirds of this cost is caused by productivity loss due to pain symptoms [11,17].…”