title: The direct and indirect costs associated with endometriosis: a systematic literature review.
abstract: OBJECTIVE
  What is the economic burden of endometriosis?
  
  
  CONCLUSIONS
  The identified studies indicate that there is a significant economic burden associated with endometriosis, as observed by both direct and indirect costs.
  
  
  BACKGROUND
  Two previous systematic literature reviews suggested that there were considerable direct costs associated with endometriosis and there was a general lack of measurement of indirect costs.
  
  
  METHODS
  We performed a systematic literature review. MEDLINE and EMBASE databases from 2000 to 2013 were searched. The literature search was limited to human studies of patients with endometriosis. Papers in languages other than English were excluded.
  
  
  METHODS
  Studies reporting direct or indirect costs among patients with endometriosis were considered for inclusion. Direct costs included inpatient, outpatient, surgery, drug and other healthcare service cost. Indirect costs were related to absenteeism and presenteeism (lost productivity at work).
  
  
  RESULTS
  After evaluating the 1396 articles in the search results, 12 primary studies that reported direct or indirect costs associated with endometriosis were identified and included in the data extraction. Three of the studies were conducted in the USA, one study each was conducted in Austria, Belgium, Brazil, Canada, Finland, Germany and Italy, and two studies included data from 10 countries. Significant variability was observed in the reviewed studies in methodology, including data source, cost components considered and study perspective. Estimates of total direct costs ranged from $1109 per patient per year in Canada to $12 118 per patient per year in the USA. Indirect costs of endometriosis ranged from $3314 per patient per year in Austria to $15 737 per patient per year in the USA.
  
  
  CONCLUSIONS
  The studies identified in the systematic literature review varied greatly by study methodology as well as by country owing to different healthcare systems and costs of healthcare services, which contributed to large variations in the direct and indirect cost estimates.
  
  
  CONCLUSIONS
  A majority of the studies we found were published after the periods covered in the prior systematic literature reviews, which provided substantial contributions to an understanding of the economic burden of endometriosis, especially in the area of indirect costs. The long-term burden of endometriosis following diagnosis is still under-studied, which is a concern given the chronic nature of the disease and the substantial recurrence of endometriosis symptoms.
  
  
  BACKGROUND
  This study was funded by AbbVie, which also develops the oral GnRH antagonist elagolix (in collaboration with Neurocrine Biosciences) for the management of endometriosis and uterine fibroids. A.M.S. is an employee of AbbVie and currently owns AbbVie stocks. H.Y., E.X.D. and C.K. are employees of Analysis Group, Inc., which has received consultancy fees from AbbVie. C.W. is a Clinical Professor at the Department Obstetrics and Gynecology at Georgetown University in Washington, DC, USA and has served in a consulting role to AbbVie for this project.
authors: AbbVie, Inc., 1 North Waukegan Road, North Chicago, IL 60064, USA ahmed.m.soliman@abbvie.com.
authors: Ahmed M
authors: AM
authors: Soliman
authors: Analysis Group, Inc., 111 Huntington Avenue, Boston, MA 02199, USA.
authors: Hongbo
authors: H
authors: Yang
authors: Analysis Group, Inc., 111 Huntington Avenue, Boston, MA 02199, USA.
authors: Ella Xiaoyan
authors: EX
authors: Du
authors: Analysis Group, Inc., 111 Huntington Avenue, Boston, MA 02199, USA.
authors: Caroline
authors: C
authors: Kelley
authors: Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC 20007, USA.
authors: Craig
authors: C
authors: Winkel
mesh_terms: D000041:Absenteeism; D017281:Cost of Illness; D004180:Direct Service Costs; D004715:Endometriosis / Q000191:economics / Q000628:therapy*; D005260:Female; D000071219:Global Burden of Disease / Q000191:economics; D014943:Global Health / Q000191:economics; D005102:Health Expenditures; D006801:Humans
keywords: absenteeism; direct costs; economics; endometriosis; healthcare costs; indirect costs; presenteeism