Endometriosis: economic impact and need for centers of excellence

Direct endometriosis-related costs are considerable, appear to be driven by hospitalizations, and have increased with 61% between 1993 and 2002 in the USA, despite a decline in the endometriosis-related hospital length of stay during the same period. Studies evaluating the cost of endometriosis in infertile patients and the indirect endometriosis-associated costs are largely lacking. Assuming a 10% prevalence rate of endometriosis among women of reproductive age, it has been estimated that the annual costs of endometriosis attained $22 billion in the USA only in 2002. In this age group, these costs are considerably higher than those related to Crohn's disease, migraine, hypertension and comparable to the cost of diabetes. Furthermore, endometriosis-related costs are increasing, in contrast with the decreasing direct costs associated with PID. Due to the added cost related to comorbid conditions like interstitial cystitis, depression, migraine, irritable bowel syndrome, chronic fatigue syndrome, abdominal pain and infertility, women with endometriosis incurred total direct medical costs that were, on average, 63% higher than medical costs for the average women in a commercially insured group in the USA in 2004.

Centres/networks of excellence are the only way forward to ensure that women with endometriosis receive consistent, evidence-based care ensuring excellence, continuity of care, multi-disciplinarity, research, training and cost-effectiveness. Clinical excellence should be achieved by proper training, adherence to guidelines of evidence based medicine, quality management and continuous measurement of patient outcome as a central focus. To ensure continuity of care, the first step is to assign to each patient a „central gynaecologist“ who must have continuously updated knowledge regarding all diagnostic and management options for endometriosis, and who must set priorities and realistic expectations together with the woman using a long term multidisciplinary treatment plan. Scientific research within and scientific collaboration between centres/networks of excellence will create the critical mass of patients and tissue samples that is needed to make progress. Centres/networks of excellence should be accredited as training centers by professional bodies. They should aim at improving the cost-effectiveness of the management of endometriosis by a reduction in the time to diagnosis, a reduction in the time before individualised specialist care is invoked, a reduction of expensive „hit and miss“ treatments, and a reduction in expensive fertility treatments, if the disease is under control before fertility is impaired.

References: D'Hooghe TM and Hummelshoj L. (2006) Multi-disciplinary centres/networks of excellence for endometriosis management and research: a proposal. Human Reprod;21(11);2743–48. Gao X, Outley JK, Botteman M, Spalding J, Simon JA and Pashos CL (2006) The economic burden of endometriosis. Fertil Steril 86, 1561–1572. Simoens S, Hummelshoj L, D'Hooghe TM. (2007) Endometriosis: cost estimates and methodological perspective. Hum Reprod Update 13:395-404.