title: Economic burden of endometriosis.
abstract: OBJECTIVE
  To comprehensively review and evaluate the direct costs of endometriosis.
  
  
  METHODS
  We systematically reviewed studies published since 1990, and conducted an analysis of publicly available national databases (Healthcare Cost and Utilization Project and National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey) in the United States. We assessed: [1] the overall economic impact of endometriosis; [2] the direct costs associated with specific treatments; and [3] the indirect costs of endometriosis associated with reduced work productivity.
  
  
  RESULTS
  Of 13 published studies meeting inclusion criteria, 11 (85%) addressed direct costs, a few studies addressed outpatient costs or indirect costs, and no study quantified the economic impact among adolescents. Direct endometriosis-related costs were considerable and appeared driven by hospitalizations. Our database analysis found: [1] as endometriosis-related hospital length of stay steadily declined from 1993 to 2002, per-patient cost increased 61%; [2] adolescents (aged 10-17 years) had endometriosis-related hospitalizations; [3] approximately 50% of >600,000 endometriosis-related ambulatory patient visits involved specialist care; and [4] females 23 years old or younger constituted >20% of endometriosis-related outpatient visits.
  
  
  CONCLUSIONS
  Health economic information for endometriosis is scarce, limiting our understanding of its overall economic impact. Nevertheless, the literature and other available data suggest that endometriosis places a considerable burden on patients and society.
authors.affiliation: Health Economic Research and Quality of Life Evaluation Services, Abt Associates, Inc., Bethesda, Maryland 20814-5341, USA. cindy_gao@abtassoc.com <cindy_gao@abtassoc.com>
authors.forename: Xin
authors.initials: X
authors.lastname: Gao
authors.forename: Jackie
authors.initials: J
authors.lastname: Outley
authors.forename: Marc
authors.initials: M
authors.lastname: Botteman
authors.forename: James
authors.initials: J
authors.lastname: Spalding
authors.forename: James A
authors.initials: JA
authors.lastname: Simon
authors.forename: Chris L
authors.initials: CL
authors.lastname: Pashos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D017281:Cost of Illness; D004651:Employment / Q000191:economics* / Q000706:statistics & numerical data; D004715:Endometriosis / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D017699:Pelvic Pain / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D014481:United States / Q000453:epidemiology