Patient Treatment Journey and Burden Associated With Endometriosis: A Retrospective Claims Database Analysis

Objective: Present the treatment journey of women with endometriosis and associated healthcare resource utilization (HCRU) and costs. Design: Retrospective claims data analysis. Setting: January 1, 2016, to December 31, 2021, Merative™ MarketScan ® Research Database. Population: Women 18 to 55 years with ≥2 diagnosis codes for endometriosis within the study period, and ≥1 initial diagnosis code for endometriosis between January 1, 2018, and December 31, 2019 (longitudinal cohort, n=6612), or ever in 2021 (cross-sectional cohort). Methods: Data were extracted from claims and assessed descriptively. The cross-sectional endometriosis cohort (n=15,228) was compared with an age-matched control cohort without endometriosis (n=37,596). HCRU and costs were calculated on a per-patient basis averaged across the cohort for 2021. Chi-squared tests or Wilcoxon rank-sum test, without imputation or adjustment, were used to determine statistical significance between endometriosis and control cohorts. Main Outcome Measures: Treatment frequency and sequencing patterns of pharmacologic treatments and surgical procedures, HCRU, and costs. Results : The most common newly initiated treatment at diagnosis was surgery (52%). Women with endometriosis were more often also diagnosed with infertility, anxiety, and depression (all P <0.01, vs control). Correspondingly, women with endometriosis were significantly more likely to be treated with hormonal medications, and anxiolytics/antidepressants (all P <0.01, vs control), and undergo gynecologic procedures and surgeries (all P <0.01), contributing to approximately 3 times greater overall healthcare costs than women in the control cohort ($20,381 vs $7000, respectively; P <0.0001). Conclusions: Women with endometriosis experience substantial symptom burden and are most often treated with surgical procedures contributing to greater HCRU and costs.