Economic Burden of Endometriosis: A Systematic Review

At present, few discussions have addressed the economic burden of endometriosis. The present study aimed to update two previous reviews and to assess the current body of literature regarding the costs associated with endometriosis. We searched the PubMed, EMBASE and The Cochrane Library databases using “endometriosis”, “economics”, “costs”, “productivity”, “insurance” and “burden” as search terms to identify articles published between 2004 and 2015. To enable the performance of comparisons across reported studies, cost findings were converted to international dollars using purchasing power parities (PPPs) and then inflated to 2010 dollars using the Consumer Price Index (CPI). The search yielded 11 relevant articles. Of these articles, four evaluated direct costs, one analysed indirect costs, and six reported both direct and indirect costs. Based on the results of these studies, endometriosis was estimated to account for annual total costs of Int$-PPP 2.193-8.475 in newly diagnosed women and Int$-PPP 11.688-12.941 in previously diagnosed women. The indirect costs associated with this condition were much higher for previously diagnosed women than newly diagnosed women. The included articles varied considerably in terms of study design, included cost categories and methodological quality. Although it has been ten years since seven methodological considerations for designing future endometriosis cost studies were defined, the application of these recommendations was infrequently identified in the current body of literature. As endometriosis affects women of reproductive and, thus, working age chronically, the indirect costs of endometriosis are especially high. Accordingly, future studies must better explore the manner in which costs, particularly indirect costs, accrue among women affected by endometriosis to best facilitate health and social policy interventions.