title: The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres.
abstract: BACKGROUND
  This study aimed to calculate costs and health-related quality of life of women with endometriosis-associated symptoms treated in referral centres.
  
  
  METHODS
  A prospective, multi-centre, questionnaire-based survey measured costs and quality of life in ambulatory care and in 12 tertiary care centres in 10 countries. The study enrolled women with a diagnosis of endometriosis and with at least one centre-specific contact related to endometriosis-associated symptoms in 2008. The main outcome measures were health care costs, costs of productivity loss, total costs and quality-adjusted life years. Predictors of costs were identified using regression analysis.
  
  
  RESULTS
  Data analysis of 909 women demonstrated that the average annual total cost per woman was €9579 (95% confidence interval €8559-€10 599). Costs of productivity loss of €6298 per woman were double the health care costs of €3113 per woman. Health care costs were mainly due to surgery (29%), monitoring tests (19%) and hospitalization (18%) and physician visits (16%). Endometriosis-associated symptoms generated 0.809 quality-adjusted life years per woman. Decreased quality of life was the most important predictor of direct health care and total costs. Costs were greater with increasing severity of endometriosis, presence of pelvic pain, presence of infertility and a higher number of years since diagnosis.
  
  
  CONCLUSIONS
  Our study invited women to report resource use based on endometriosis-associated symptoms only, rather than drawing on a control population of women without endometriosis. Our study showed that the economic burden associated with endometriosis treated in referral centres is high and is similar to other chronic diseases (diabetes, Crohn's disease, rheumatoid arthritis). It arises predominantly from productivity loss, and is predicted by decreased quality of life.
authors.affiliation: Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Simoens
authors.forename: Gerard
authors.initials: G
authors.lastname: Dunselman
authors.forename: Carmen
authors.initials: C
authors.lastname: Dirksen
authors.forename: Lone
authors.initials: L
authors.lastname: Hummelshoj
authors.forename: Attila
authors.initials: A
authors.lastname: Bokor
authors.forename: Iris
authors.initials: I
authors.lastname: Brandes
authors.forename: Valentin
authors.initials: V
authors.lastname: Brodszky
authors.forename: Michel
authors.initials: M
authors.lastname: Canis
authors.forename: Giorgio Lorenzo
authors.initials: GL
authors.lastname: Colombo
authors.forename: Thomas
authors.initials: T
authors.lastname: DeLeire
authors.forename: Tommaso
authors.initials: T
authors.lastname: Falcone
authors.forename: Barbara
authors.initials: B
authors.lastname: Graham
authors.forename: Gülden
authors.initials: G
authors.lastname: Halis
authors.forename: Andrew
authors.initials: A
authors.lastname: Horne
authors.forename: Omar
authors.initials: O
authors.lastname: Kanj
authors.forename: Jens Jørgen
authors.initials: JJ
authors.lastname: Kjer
authors.forename: Jens
authors.initials: J
authors.lastname: Kristensen
authors.forename: Dan
authors.initials: D
authors.lastname: Lebovic
authors.forename: Michael
authors.initials: M
authors.lastname: Mueller
authors.forename: Paola
authors.initials: P
authors.lastname: Vigano
authors.forename: Marcel
authors.initials: M
authors.lastname: Wullschleger
authors.forename: Thomas
authors.initials: T
authors.lastname: D'Hooghe
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D017281:Cost of Illness; D004715:Endometriosis / Q000150:complications / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007247:Infertility, Female / Q000150:complications; D017699:Pelvic Pain / Q000150:complications; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012044:Regression Analysis; D062606:Tertiary Care Centers