Changes in Healthcare Spending After Diagnosis of Comorbidities Among Endometriosis Patients: A Difference-in-Differences Analysis

Abstract

IntroductionWe sought to characterize changes in healthcare spending associated with the onset of 22 endometriosis-related comorbidities.MethodsWomen aged 18–49 years with endometriosis (N = 180,278) were extracted from 2006–2015 de-identified Clinformatics® DataMart claims data. For 22 comorbidities, comorbidity patients were identified on the basis of having a first comorbidity diagnosis after their initial endometriosis diagnosis. Controls were identified on the basis of having no comorbidity diagnosis and were matched 1:1 to comorbidity patients on demographics and baseline spending. Total medical and pharmacy spending was measured during 12 months before and after each patient’s index date (first comorbidity diagnosis for comorbidity patients, and equal number of days after earliest endometriosis claim for controls). Pre–post spending differences were compared using difference-in-differences linear regression. Total and comorbidity-related cumulative spending per patient for all endometriosis patients were calculated annually for the 5 years following endometriosis diagnosis.ResultsThe number of endometriosis patients with each comorbidity varied between 121 for endometrial cancer and 16,177 for fatigue. Healthcare spending increased significantly with the onset of eight comorbidities: breast cancer, ovarian cancer, pregnancy complications, systemic lupus erythematosus/rheumatoid arthritis/Sjogren’s/multiple sclerosis, infertility, uterine fibroids, ovarian cyst, and headache [p < 0.001 except for headache (p = 0.045)]. Spending decreased significantly for fatigue, cystitis/UTI, and eczema [p < 0.001 except for fatigue (p = 0.048)] and was not statistically different for the other 11 comorbidities. Difference-in-differences estimates were significantly higher for comorbidity patients for all comorbidities except eczema (p ≤ 0.003). Mean 5-year total cumulative spending was $58,191 per endometriosis patient, of which between 11% and 23% was attributable to comorbidity-related medical claims.ConclusionFor all but one of the 22 comorbidities associated with endometriosis, comorbidity onset was associated with a relative increase in total healthcare spending.FundingAbbVie Inc.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-017-0630-8) contains supplementary material, which is available to authorized users.

Burden of Endometriosis: Infertility, Comorbidities, and Healthcare Resource Utilization

“…The heterogeneity of HCRU in endometriosis patients is also influenced by the development of subsequent comorbidities [41]. Increasing awareness may improve prevention and early detection.…”

“…For these reasons, our findings related to clinical characteristics and comorbidities may be generalizable to similar populations worldwide. Previous studies evaluating the impact of individual comorbidities on healthcare spending have relied on claims analysis only [41].…”

“…Autoimmune diseases were defined according to at least one ICD-9 diagnosis code from any physician, so misclassification of suspected disease is possible [5,33,34]. Previous studies have shown that women diagnosed with endometriosis were more likely than controls to be diagnosed with IBS, IBD, or other comorbidities, and there may be overlapping symptoms [5,33,34,41], underscoring the challenge of distinguishing between misdiagnosis and comorbidity.…”

Characterizing the impact of menstrual and pelvic health disorders in a convenience sample of women in Barbados

“…Presenteeism or “sickness presenteeism” 28 describes the situation when individuals, while ill or unwell, come to work but do not function at optimal capacity. 28 Many publications have confirmed that endometriosis is a debilitating condition, 13 frequently associated with absenteeism, 29–32 high levels of comorbidity, 33–35 presenteeism 24 and high financial burden due to overlapping costs of treatment and absence from work. Thus, it is thought that there is a relationship between the high value for presenteeism for endometriosis, the high financial burden associated with diagnosis, management and treatment of the condition and seeking to maintain job security to mitigate additional financial distress.…”