"Benign" Pelvic Conditions Are Associated With High Costs and Frequent Overlapping Symptomatology

OBJECTIVE: To demonstrate, using actual insurance data, that benign pelvic conditions are associated with increased health care costs and that these costs increase further with each additional coexisting benign pelvic diagnosis. METHODS: Deidentified 2022-2023, 12-month data from a private insurer were queried across benign pelvic diagnoses involving bladder, bowel, pelvic floor muscle, pelvic pain, and sexual dysfunction symptomatology (Table S1). Endometriosis and neurological diagnoses relevant to the pelvis were examined separately to assess confounding. Binary logistic regression, chi-square, and analysis of variance were utilized to determine associations. RESULTS: The database included all costs for 4306 members, mean age 35.5 (standard deviation [SD]: 20 years). Exactly 16.8% of the insured population, mean age 43 years (SD: 19 years), had benign pelvic diagnoses, and were associated with 35.2% of the plan's overall spending. Those plan members with no pelvic symptoms (n = 3586) had a significantly lower cost than those with 1 (P <.001; n = 544), 2 (P <.001; n = 159), 3 (P = .004; n = 12), and 4 (P = .044; n = 5) pelvic symptoms. Median annual cost (log scale) for all members was $2056 (interquartile range [IQR]: $465-$6969). For those with no pelvic symptoms, the median cost was $1450 (IQR: $370-$5320, n = 3586) vs a median cost of $6690 (IQR:$2618-$19,312; n = 720) in those with the presence of any pelvic symptom class. Stratified by number of pelvic symptom classes, for 1 class the median was $5806 (IQR: $2214-$16,277, n = 544); 2 classes $9282 (IQR: $4225-$23,401, n = 159); 3 classes $6173 (IQR: $5411-$30,598 n = 12), and for 4 classes $20,532 (IQR: $11,922-$51,986, n = 5). CONCLUSION: High pelvic health care utilization suggests symptoms are disruptive and persistent. Given a high prevalence of coexisting symptomatology, a multidisciplinary approach may improve outcomes and reduce costs.