Trends in Endometriosis Management: A 10-Year US Claims Analysis

STUDY OBJECTIVE: To examine real-world treatment patterns for endometriosis and their alignment with clinical best-practice recommendations. DESIGN: Observational, retrospective study from 2009 to 2022. SETTING: Two large US health insurance claims databases, MarketScan® and OPTUM®. PATIENTS: Women aged 16-45 years with continuous enrollment in OPTUM® and MarketScan® and at least 2 diagnoses of endometriosis. Hysterectomy, menopause or active treatment of malignancy were exclusion criteria. INTERVENTIONS: Pharmacological therapy (including OCPs, POPs, GnRH analogs, opioids), and surgical management (including laparoscopy and hysterectomy). MEASUREMENTS: Frequencies, means, Time-to-event Kaplan-Meier curves, and Sankey diagrams were used to examine treatment initiation, frequencies and sequences. MAIN RESULTS: A total of 22 317 participants from OPTUM® and 54 630 from MarketScan® were included. Most of these patients (71.0% OPTUM®, 72.1% MarketScan®) received surgery after diagnosis of endometriosis, whereas medications were prescribed in 42.1% (OPTUM®) and 44.9% (MarketScan®). Surgery was performed as a first-line intervention in 37.6% (n = 8395, including 4481 laparoscopies and 3914 hysterectomies in OPTUM®) and 41.8% (n = 22 858, including 13 175 laparoscopies and 9683 hysterectomies in MarketScan®). Among first-line surgeries (n = 8395 OPTUM®, n = 22 858 MarketScan®), laparoscopies accounted for over half (53.4%, n = 4481 OPTUM®; 57.6%, n = 13 175 MarketScan®), while hysterectomies comprised nearly half (46.6%, n = 3914 OPTUM®; 42.4%, n = 9683 MarketScan®). Pharmacotherapy was used first-line in 49.9% (n = 11 135) of OPTUM® and 45.5% (n = 24 840) of MarketScan®. Opioids were used first-line in 12.5% (n = 2787) OPTUM® and 12.7% (n = 6932) MarketScan®. Pharmacological therapies were started as first-line intervention within 15-23 weeks, and surgeries were performed within 16-18 weeks after diagnosis. Those with gynecologic comorbidities had a shorter diagnosis-to-treatment interval than those with mental health and pain comorbidities. CONCLUSION: Therapies for endometriosis are generally started within 4-6 months of diagnosis. Surgery is used more frequently than medical management, and in the majority of cases, surgery was first-line intervention. Opioids are still frequently prescribed despite strong guidelines recommending against their use.