Sunday, March 9, 2014

Cost $$ of Endo

"...Estimates of endometriosis costs for the USA in 2002. Total costs are substantial and ranged $2–110 billion depending on prevalence rates. Direct healthcare costs make up 78% of total costs arising from endometriosis. Annual indirect costs of time lost from work due to endometriosis amounted to $0.5–24 billion....Endometriosis imposes a substantial economic burden on society. The high burden originates from the time delay between onset of symptoms and diagnosis, costly medical and surgical treatments, the chronic nature of endometriosis and the indirect costs associated with reduced quality of life and ability to work. Increasing awareness of the disease, cutting the time to diagnosis and providing centralized evidence-based specialized care are crucial steps in reducing the morbidity, health care expenditure and lost productivity associated with endometriosis. The substantial economic burden underlines the need for further research into cost-effective approaches to diagnosing and treating endometriosis...."
"The ability to diagnose endometriosis by means of laparoscopy depends on the surgeon's skills and experience. As a result, 3–12 years may pass between symptom onset and definitive diagnosis (Arruda et al., 2003; Husby et al., 2003). During this time period, unnecessary investigations and treatments are likely to be initiated, thus representing a cost of obtaining a diagnosis for women presenting with symptoms that may have several different causes. Better diagnostic methods would alleviate some of the distress felt between symptom onset and diagnosis and treatment, although the net effect on costs is unclear....In addition to difficulties involved in diagnosing endometriosis, costs appear to be influenced by the patient profile, specific diagnosis of endometriosis and principal procedure performed. An analysis of inpatient endometriosis treatment showed that costs were higher in older women and in African-American women as compared with Caucasian women. The specific diagnosis appears to play a role: endometriosis of the intestine and of the skin was associated with higher and lower inpatient costs, respectively, than endometriosis at other sites (Zhao et al., 1998a). Of the surgical interventions of endometriosis, total abdominal hysterectomy generated higher inpatient costs than other procedures (Zhao et al., 1998a; Gao et al., 2006).... Employed women incur indirect costs of time lost from work due to endometriosis....Little is known about the productivity loss associated with endometriosis, although available estimates from cost-of-illness analyses suggest that endometriosis may impose considerable indirect costs. Estimates of the number of hours missed from work due to endometriosis ranged 19.2–86.4 h per patient per year (Kunz et al., 1995; Mathias et al., 1996)....First of all, there is currently no reliable non-surgical diagnostic test for endometriosis. Thus diagnosis requires laparoscopy, preferably with histological confirmation. If endometriosis is present at laparoscopy, it is recommended that it is surgically removed at the same time as diagnosis, as an effective treatment for endometriosis-associated subfertility and pain (Kennedy et al., 2005). Secondly, the lower costs of medical treatment need to be balanced by additional costs due to higher recurrence rates of endometriosis with medical when compared with surgical treatment (Wellbery, 1999; D'Hooghe et al., 2003b; Winkel, 2003)...."