Incremental costs of healthcare and work loss attributed to endometriosis in a cohort of commercially insured women

To quantify incremental direct healthcare costs and indirect costs among newly-diagnosed endometriosis patients compared to patients without an endometriosis diagnosis. Retrospective cohort study using a deidentified administrative claims database. Truven Health MarketScan Commercial claims and Health and Productivity Management Databases were used to identify women aged 18-49 newly diagnosed with endometriosis (ICD-9-CM 617.xx) between January 2010 and June 2014 (index date). Age- and gender-matched controls selected from the database and were assigned index dates matching the distribution of endometriosis patients index dates. Women with 12 months continuous enrollment pre- and post-index and no evidence of endometriosis pre-index were included in the analysis. Study outcomes were annual direct healthcare costs (medical and pharmacy costs) and indirect costs (absenteeism, short-term and long-term disability) for 12-months post-index in 2014 US$. Indirect costs were assessed on a subset of patients with available data. Multivariable gamma regression models were used to estimate incremental costs associated with endometriosis while controlling for baseline demographic and clinical characteristics. The final study sample included 113,506 endometriosis patients and 927,599 controls. Among endometriosis patients, unadjusted and multivariable-adjusted annual direct costs and indirect costs were significantly higher for endometriosis patients (table). Pharmacy costs were 11% of healthcare costs among endometriosis patients, and 26% among controls. The majority (62%) of annual costs for endometriosis patients were incurred within 3 months post-index. Endometriosis was associated with substantial incremental direct and indirect costs among commercially insured patients in the United States. Given its prevalence, this suggests substantial disease burden associated with endometriosis to the individual, health care system, and society.Tabled 1Multivariable-adjusted 12-month costs per patient (2014 $)Endometriosis PatientsControlsAdjusted differenceTotal Healthcare Costs(N = 1,041,105)$14,648$4,646$10,002Indirect costs: Absence(N = 11,416)$5,157$4,254$903Indrect costs: Short-term disability(N = 87,967)$1,632$404$1,228Total Indirect Costs$6,819$4,687$2,132All cohort differences are statistically significant, P control cohort Open table in a new tab