AGES XXIII Annual Scientific Meeting 2013 Abstracts & Program

The Pelvis in Pain
Program Abstracts - Saturday 9 March
Endometriosis and Beyond
Meeting of the American Society for Reproductive
Medicine (ASRM) Denver
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AUTHOR AFFILIATION: Ms Taryn Hallam;
Physiotherapist, Alana Health Care for Women, Sydney, New
South Wales, Australia. Lecturer, Women’s Health Training
Associates, Australia.
SESSION 10 / 1130-1200
The price of pain
D’Hooghe TM
The price of endometriosis-associated pain will be discussed
based on a systematic review and on 2 studies sponsored by
the World Endometriosis Research Foundation: the Endocost
study and the Global Study on Women’s Health (GSWH).
The GSWH study (Nnoaham et al, 2012) assessed the
impact of endometriosis on health-related quality of life
(HRQoL) and work productivity prospectively in 16 clinical
centers in 10 countries, including 1,418 premenopausal
women without a previous surgical diagnosis of
endometriosis, having laparoscopy to investigate symptoms
or to be sterilized. There was a delay of 6.7 years, principally
in primary care, between onset of symptoms and a surgical
diagnosis of endometriosis, which was longer in centers
where women received predominantly state-funded health
care (8.3 vs. 5.5 years). Delay was positively associated
with the number of pelvic symptoms (chronic pelvic pain,
dysmenorrhoea, dyspareunia, and heavy periods) and a
higher body mass index. Physical HRQoL was significantly
reduced in affected women compared with those with
similar symptoms and no endometriosis. Each affected
woman lost on average 10.8 hours (SD 12.2) of work weekly,
mainly owing to reduced effectiveness while working. Loss
of work productivity translated into significant costs per
woman/week, from US$4 in Nigeria to US$456 in Italy
(Nnoaham et al, 2012).
In a systematic review of cost-of-illness analyses
quantifying the economic impact of endometriosis and
cost analyses calculating diagnostic and treatment costs
of endometriosis, annual healthcare costs and costs of
productivity loss associated with endometriosis were
estimated at $2,801 and $1,023 per patient, respectively
(Simoens et al, 2007). Extrapolating these findings to the
US population, this study calculated that annual costs of
endometriosis attained $22 billion in 2002 assuming a
10% prevalence rate among women of reproductive age.
These costs are considerably higher than those related to
Crohn’s disease or to migraine. Based on this review, it was
not possible to determine whether a medical approach is
less expensive than a surgical approach in the treatment of
patients with endometriosis presenting with chronic pelvic
pain (Simoens et al, 2007).
The ENDOCOST study was a prospective, international,
multi-centre questionnaire-based survey which measured
costs and quality of life of women with endometriosisassociated
symptoms in ambulatory care and in 12 tertiary
care centres in ten countries (Simoens et al, 2012). Data
analysis of 909 women demonstrated that the average annual
total cost per woman was €9,579 (95% CI €8,559-€10,599).
Costs of productivity loss of €6,298 per woman were double
the health care costs (€3,113 per woman). Health care
costs were mainly due to surgery (29%), monitoring tests
(19%) and hospitalization (18%). Endometriosis-associated
symptoms generated 0.809 quality-adjusted life years per
woman. Decreased quality of life was the most important
predictor of direct health care and total costs. Costs were
greater with increasing severity of endometriosis, presence
of pelvic pain, presence of infertility, and higher number
of years since diagnosis. These data demonstrate that the
economic burden associated with endometriosis treated
in referral centres is high and is similar to other chronic
diseases (diabetes, Crohn’s disease, rheumatoid arthritis). It
arises predominantly from productivity loss, and is predicted
by decreased quality of life.
In conclusion, endometriosis impairs HRQoL and work
productivity across countries and ethnicities, yet women
continue to experience diagnostic delays in primary care.
Decreased quality of life is the most important predictor of
direct health care and total costs, that increase with increasing
severity of endometriosis, presence of pelvic pain, presence of
infertility, and higher number of years since diagnosis.