Direct cost of deep infiltrating endometriosis surgically treated in a German referral center

Deep infiltrating endometriosis (DIE) is a complex disease, leading to diverse symptoms in affected women of reproductive age. This retrospective study aimed to describe patient characteristics and to calculate the direct costs during inpatient stay for surgery in women with DIE affecting bowel and bladder treated in a referral center in Germany.

A retrospective evaluation of patient data of a German referral center was conducted. Preoperative characteristics and cost relevant factors of women with DIE of bladder or bowel who had undergone inpatient surgical treatment between 2008 – 2012 were gathered from hospital records. Respective economic data were retrieved from the hospital's finance and accounts department. Data were analysed for total of cases and for three groups, classified by severity according to the revised American Society for Reproductive Medicine (rASRM) score.

148 cases with complete clinical information and cost data were analysed retrospectively. Most of the cases had bowel endometriosis (91%) and were classified as severe (66%). The affected women analysed in this study were in their reproductive peak years (34 years; ± SD 6.3 years), of normal weight (BMI 23; ± SD 4.0) and most of them employed (80%). More than 95% of women were affected by multiple symptoms at hospital admission and the majority of cases treated showed a history of endometriosis (76%). Mean total costs per case were 11,458€ per case (95% CI: 10,589€ – 12,326€): 44% of it were mean staff costs (5,039€), followed by 30% mean costs for facilities and utilities (3,425€) and 26% mean material costs (2,993€).

The present study is the first attempt to estimate the surgery related direct costs of DIE from a hospital's perspective. Due to the complexity of surgical DIE treatment and impressive recurrence rate, resource consumption of this chronic disease is high and total costs are substantial. Earlier diagnosis of DIE avoiding progression may decrease healthcare consumption and reduce costs to patients, care providers and society. Further studies on DIE are needed to complete the knowledge of the economic burden of this severe chronic disease and to identify cost-effective treatment strategies.