What it costs to have endometriosis

J Manag Care Pharm. 2007 Apr;13(3):262-72.

Actuarial analysis of private payer administrative claims data for women with endometriosis.

Mirkin D, Murphy-Barron C, Iwasaki K.

Author information

Abstract

BACKGROUND:

Endometriosis is a painful, chronic disease affecting 5.5 million women and girls in the United States and Canada and millions more worldwide. The usual age range of women diagnosed with endometriosis is 20 to 45 years. Endometriosis has an estimated prevalence of 10% among women of reproductive age, although estimates of prevalence vary greatly. Endometriosis is the most common gynecological cause of chronic pelvic pain, but published information on its associated medical care costs is scarce.

OBJECTIVE:

The aim of this study was to determine (1) the prevalence of endometriosis in the United States, (2) the amount of health care services used by women coded with endometriosis in a commercial medical claims database during 1999 to 2003, and (3) the endometriosis-related costs for 2003, the most recent data available at the time the study was performed.

METHODS:

This study was a retrospective review of administrative data for commercial payers, which included enrollment, eligibility, and claims payment data contained in the Medstat Marketscan database for approximately 4 million commercial insurance members. All claims and membership data were extracted for each woman aged 18 to 55 years who had at least 1 medical or hospital claim with a diagnosis code for endometriosis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 617.00-617.99) for 1999 through 2003. Claims data from 1999 through 2003 were used to determine prevalence and health care resource utilization (i.e., annual admission rate, annual surgical rate, distribution of endometriosis-related surgeries, and prevalence of comorbid conditions). The cost analysis was based on claims from 2003 only. Cost was defined as the payer-allowed charge, which equals the net payer cost plus member cost share.

RESULTS:

The prevalence of women with medical claims (inpatient and/or outpatient) containing ICD-9-CM codes for endometriosis was 1.1% for the age band of 30 to 39 years and 0.7% over the entire age span of 18 to 55 years. The medical costs per patient per month (PPPM) for women with endometriosis were 63% greater ($706 PPPM) than those of the average woman per member per month ($433) in 2003; inpatient hospital costs accounted for 32% of total direct medical costs. Between 1999 and 2003, these women with endometriosis who were identified by either inpatient and/or outpatient claims had high rates of hospital admission (53% for any reason; 38% for an endometriosis-related reason) and a high annual surgical procedure rate (64%). Additionally, women with endometriosis frequently suffered from comorbid conditions, and these conditions were associated with greater PPPM costs of 15% to 50% for women with an endometriosis diagnosis code, depending on the condition. Interstitial cystitis was associated with 50% greater cost ($1,061 PPPM); depression, 41% ($997 PPPM); migraine, 40% ($988 PPPM); irritable bowel syndrome, 34% ($943 PPPM); chronic fatigue syndrome, 29% ($913 PPPM); abdominal pain, 20% ($846 PPPM); and infertility, 15% ($813 PPPM).

CONCLUSIONS:

Women with endometriosis have a high hospital admission rate and surgical procedure rate and a high incidence of comorbid conditions. Consequently, these women incur total medical costs that are, on average, 63% higher than medical costs for the average woman in a commercially insured group.

PMID:

 

17407392

 

[PubMed - indexed for MEDLINE] 

Fre

Pesticides Linked to Endometriosis Risk

By NICHOLAS BAKALAR

Why some women and not others get endometriosis — the growth of uterine tissue outside the uterus that can cause pain and infertility — is not known, but researchers have come up with one possible contributing factor: pesticide poisoning.

Scientists studied 248 women with surgically confirmed endometriosis and 538 healthy controls. They measured blood levels of two pesticides, mirex and beta HCH, which persist in some fish and dairy products even though their use in the United States has been banned for decades. The studyappears online in Environmental Health Perspectives.

Read more: http://well.blogs.nytimes.com/2013/11/05/pesticides-linked-to-endometriosis/?_r=0

WHAT IF ENDOMETRIOSIS WAS A MEN’S HEALTH ISSUE?

The world would be a different place!
JORDAN DAVIDSON

As a health journalist and a co-founder of Endo Warriors, a support organization for women with endometriosis, I often get asked “what is endometriosis?”

Which is funny since it is estimated that 176 million women worldwide have endometriosis and yet no one knows about this global health issue.

http://www.hormonesmatter.com/endometriosis-mens-health-issue/

Visit Endo Warriors - https://www.facebook.com/endowarriorssupport

Abdominal pain may be sign of endometriosis

By Christi Myers



HOUSTON (KTRK) -- Women who experience unexplained abdominal pain could be facing endometriosis. The condition can be difficult to diagnose, so here's what women need to look for when it comes to that.


"The nurse and the doctor both looked at me and looked at my stomach and said, 'You look like you're seven months pregnant' and I'm like, 'I know and I'm not pregnant,'" Janet Strickland said.

Strickland was frustrated by her swollen abdomen and the pain she was having. She spent thousands of dollars on tests but got no answers.

"Everyone of those six doctors had told me there's nothing wrong with me," she said.

The doctors were wrong. After four years janet finally got an answer. Fertility Specialists of Houston Dr R.K. Mangal found severe endometriosis, which occurs when the menstrual flow goes back into the body, coating organs like glue.

"It spreads out to the pelvis, into the bowel cavity; we've seen it in lungs, we've seen it in patients with the diaphragm, so anywhere in the abdominal cavity which makes sense," Dr. Mangal said.

Endometriosis can start with painful menstrual cramps, pain during sex, bladder pain, colon pain, and infertility and more. Treatment often starts with the birth control pill to reduces the flow, and laser surgery to remove endometriosis from internal organs.

"I might have been with another doctor and they might have just wanted to do a total hysterectomy because I had it all over," Strickland said.

Instead Dr. Mangal was able to remove it but it took two surgeries to do it, and despite damage that remains, children are still possible.

"I think Janet has a good chance of having a baby," Dr. Mangal said.

But the surgeries, the tests and the pain could have been avoided had one of the first six doctors found it earlier.

Many women only discover they have endometriosis when they have infertility problems. Experts say by catching it early, women can often avoid infertility issues.

What you don't know can hurt you: Knowledge is Power in a Doctor/Patient Relationship

Meet Jennifer Lewis, a long time endo sufferer and advocate for victims of endometriosis.


What you don't know can hurt you: Knowledge is Power in a Doctor/Patient Relationship
By Jennifer Lewis | October 7, 2011


I was intimidated from the get-go. I was a 23 year old woman going on her fourth Laparoscopy for endometriosis. I had been experiencing severe pain and abnormal bleeding with and w/o my periods since I was fifteen, diagnosed with endometriosis at eighteen and already had three surgical laparoscopies to remove the endometial growths. This time the doctor wanted to try a different technique called a LUNA or uterine ablation. This procedure severs the ligaments in the uterus thus reducing pain created by cramping during menstruation. By this time I was having varying degrees of bleeding throughout the month as well as pain that did not correlate with my periods. I thought, "what the heck, maybe the fourth times’ a charm". I didn’t research the fact that LUNA’s are only of considerable benefit to women with pain DIRECTLY associated with their periods. At the time of the surgery I was in pain 75% of the time, and it was NOT only related to what by now had become unbearable menstruation. By the time I was 25 I had two more similar surgeries to relieve pain and abnormal bleeding caused by the regrowth of the endometrial tissue. I inquired on more than one occasion about a hysterectomy but was told by the heroes in white coats that I was either too young, I would regret it, menopause at my age would be ghastly, maybe I should seek therapy and learn to "live" with the pain"(that was a good one!) or that I should, as one of my FORMER GYN’s put it, "Swallow the pain medication and Buck Up". Essentially, I let my doctor be the ringmaster of the circus inside my body. I was intimidated by the number of degrees on his walls and the various snapshots of smiling new mothers and newborns; all having had complete faith in this physician to lead them down the path to a better life. Why should I think any different? I mean, who am I, Jennifer, to question a man who spent half his life learning how to practice medicine? But my gut and my instinct were pulling me in another direction; a direction that saved my life.

Only after seven surgical procedures, years on addictive narcotic medications, high doses of mind altering hormones, ER visits, catheterizations and mental anguish did I learn how to learn about being a patient. After experiencing fear and abandonment along with complete lack of faith in both the field of medicine and the doctors who practice it did I begin my true healing. Essentially, I became my own health advocate, and it changed my life.

Knowledge is power, plain and simple. Whether you are stricken with a life threatening illness or dealing with a persistent problem that affects the quality of your life you must take your health and any problems associated with it and ATTACK it with knowledge. In being your own advocate, it is essential that you approach your provider with sense of self and dignity; a competent individual who is aware of her own body. Your own research on and about the issue at hand is vital as well as your own personal ammunition; use it! As much as your physician would like to be, she/he may not be current on all of the cutting edge research and experimental trials that you may be eligible for. Go to the local University or college and research the medical section. The local hospital will also have up to date periodicals and medical journals that may contain useful information. In doing your own research, you become better able to understand your options. Only then can you make an informed consent on the treatment best suited for you. Utilize your provider as you would a consultant. This will enable a mutually effective exchange and your doctor will not only respect your interest in your own healthcare but respond to it.

It took me ten years of chasing white coats until I sat still enough to see my pattern. Be it intimidation, laziness or apathy, I had no regard for my most precious gift, my health. This is a society where we are inherently trained to entrust our healthcare in the hands of doctors. Asking for a second opinion, questioning a test result or inquiring about or expressing concerns over medications you may be taking can be difficult at best. When I was faced with the option of having my seventh surgery I began to really sit and think about my body, my goals (realistic) of the outcome of the surgery as well as the quality of my life. I was not comfortable speaking freely and easily with my current provider so I changed doctors. Instead of walking in her office uninformed, I confidently presented her with a list of questions I had, similar case studies and outcomes of the treatments and my realistic goals. I was able to weigh the pros and the cons intelligently and make an informed decision based on both my research and her professional experience. Less than two weeks later I had a total hysterectomy, something I had wanted and inquired about many times before only to be told that I could not possibly know for certain that was what I wanted because I was too young, too disillusioned or just too naïve about the consequences. Only after ten years did I find restitution in having the total hysterectomy and the ironic thing is that I was fought all that time by the doctors who proclaimed they wanted to help me. I got better when I finally decided to help myself.

Questions to ask your doctor include:

What are the benefits of doing this?
What are the risks involved?
What are my other options?
What should I do first?
What are the probable outcomes of each of these options?
What are the probable outcomes if I decide NOT to do this?
How many times have you performed/administered this drug before and what were the outcomes?

Remember, this is your body, your healthcare and your decision. Every woman has the potential to be her own powerhouse when it comes to her body, seize the opportunity or someone in a white coat will.

Jennifer Lewis
Author, Endometriosis: One Womans Journey
Freelance writer


http://hcp.obgyn.net/hysterectomy/content/article/1760982/1965908

Endometriosis.

Niger J Med. 2011 Apr-Jun;20(2):191-9.
Endometriosis.
Okeke TC, Ikeako LC, Ezenyeaku CC.
SourceDepartment of Obstetrics & Gynaecology University of Nigeria Teaching Hospital, Enugu, Nigeria. Ubabikctochukwu@iyahoo.comendometriosis

Abstract
BACKGROUND: Endometriosis is a common mysterious and fascinating gynaecological condition with diverse clinical manifestations, highly variable and unpredictable clinical course with decreased quality of life. Despite extensive research, endometriosis is fraught with controversies.

METHODS: Review of pertinent literature on endometriosis, selected references, internet services through gynaecological search which have been critical in the understanding of this puzzling gynaecologic condition were included in the review.

RESULTS: Endometriosis most commonly afflict women in there late 20s and 30s. The classic symptom complex include dysmenorrhoea, dyspareunia, menorrhagia and infertility. About 30% of the patients are asymptomatic. The incidence of infertility amongst women suffering from endometriosis ranges from 30%-40%. The factors implicated in causing endometriosis-associated infertility are multiple and its management is shrouded in controversy, complex and imperfectly understood.

CONCLUSION: Inspite of diverse clinical manifestations, variable and unpredictable clinical course, there is a chance to improve pregnancy rates with improvement in assisted reproductive technology.

PMID:21970227[PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/21970227