Burden of Endometriosis: Infertility, Comorbidities, and Healthcare Resource Utilization.

Vered H Eisenberg,Varda Shalev,Dean H Decter,Gabriel Chodick,Clara Weil

doi:10.3390/jcm11041133

Abstract

The goal of our study was to evaluate the burden of endometriosis in the community by comparing healthcare resource utilization, total direct medical costs, infertility, and comorbidity rates of women with and without a diagnosis of endometriosis. A retrospective case–control study was performed using the databases of a 2.1 million-member nationwide healthcare plan. The study population included women aged 15–55 years enrolled in the healthcare plan. Women with a diagnosis (ICD-9) of endometriosis were compared to controls without diagnosed endometriosis. Women were individually matched (1:4) on age and residence area. Patient characteristics were described, including infertility, comorbidities, and annual healthcare resource utilization. Total direct medical costs were analyzed in a generalized linear model adjusting for age. Women with endometriosis (n = 6146, mean age ± SD: 40.4 ± 8.0 y) were significantly more likely than controls (n = 24,572) to have a lower BMI and a higher socioeconomic status. After adjusting for BMI and socioeconomic status, endometriosis was significantly associated with infertility (OR = 3.3; 95% CI 3.1–3.5), chronic comorbidities, higher utilization of healthcare services (hospitalization: OR = 2.3; 95% CI 2.1–2.5), pain medications, and antidepressants. Women aged 15–19 y with endometriosis had substantially higher utilization of primary care visits (57.7% vs. 14.4%) and oral contraceptive use (76.9% vs. 9.6%). Direct medical costs associated with endometriosis were higher than those for controls (OR = 1.75; 95% CI 1.69–1.85). Endometriosis is associated with a high burden of comorbidities, increased healthcare resource utilization, and excess costs, particularly for younger patients whose healthcare needs may differ widely from the older population.

Highlights

Endometriosis is a benign gynecological condition defined as the presence of endometriallike glands and stroma outside of the uterus [1]
The results of this study indicate that endometriosis was significantly associated with a higher burden of infertility, chronic comorbidities, utilization of healthcare services, pain medications, and antidepressants, and overall, 1.75-fold higher direct medical costs
A meta-analysis of 24 studies showed an association between endometriosis and depressive symptoms which was mostly determined by chronic pelvic pain [29]

Summary

Introduction

Endometriosis is a benign gynecological condition defined as the presence of endometriallike glands and stroma outside of the uterus [1]. The prevalence of endometriosis is approximately 10% [2,3]; estimates differ widely due to varying study populations and designs [4]. In line with population-based estimates from European databases 1000 (95% CI 10.5–11.0) [7], which is lower than estimates based on high-risk populations. Symptoms may appear years before diagnosis [8], resulting in an average 10-year delay [2,6,9]. There are arguments for shifting diagnosis away from surgical and more towards clinical aims to focus more on the patient and less on the lesion to reduce the cost and diagnostic delay [10–12]. Endometriosis patients may pay an average of seven visits [2] to a general practitioner before being referred to a specialist and may undergo symptom treatment without a confirmed diagnosis [14], contributing to the burden on healthcare resources

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