title: Economic burden of deep infiltrating endometriosis of the bowel and the bladder in Germany: The statutory health insurance perspective.
abstract: BACKGROUND
  Until now, there has been little discussion of the costs of the deep infiltrating endometriosis (DIE) of the bowel or the bladder. The aim of the present secondary data analysis was to describe the population affected by this disease and to determine the economic burden in Germany from a payer's perspective.
  
  
  METHODS
  Health claims data of women diagnosed with DIE of the bladder or bowel, who were surgically treated as inpatients between Jan 1, 2008 and Dec 31, 2012, were evaluated retrospectively. All data were extrapolated on a national statutory health insurance (SHI) level and normalized based on the year of surgery (index year). Case-individual information on age, comorbidities and prescribed drugs were presented for the index year. Direct medical cost data were analysed before and after the index year, differentiated by cost sector and age group.
  
  
  RESULTS
  The data of 825 women with DIE were analysed. Sample size for different time points varied depending on insurance eligibility and continuous case information. The average age at surgery was 39 years. Besides DIE, 41 % of the women had at least one additional disease of the peritoneum. The mean annual total healthcare costs per DIE case were 12,868 Euros in the index year. Before surgery, mean annual costs varied between 548 and 2,475 Euros per case and after surgery between 1,739 and 2,818 Euros per case. In total, mean costs were higher in younger women as compared to older women, with a cost difference of 616 Euros over all time points.
  
  
  CONCLUSIONS
  Direct costs are highest during the year of surgical treatment, but DIE of the bowel and bladder places a substantial burden on the SHI also before and after surgery. Further studies on indirect costs would be desirable to complete the knowledge on the economic burden of DIE.
authors.affiliation: Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Germany. Electronic address: Katharina-cheryl.koltermann@charite.de.
authors.forename: Katharina C
authors.initials: KC
authors.lastname: Koltermann
authors.affiliation: Wissenschaftliches Institut der AOK (WIdO), Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schlotmann
authors.affiliation: Wissenschaftliches Institut der AOK (WIdO), Berlin, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Schröder
authors.affiliation: Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Stefan N
authors.initials: SN
authors.lastname: Willich
authors.affiliation: Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Reinhold
mesh_terms: D004715:Endometriosis / Q000191:economics* / Q000503:physiopathology*; D005260:Female; D005858:Germany; D017048:Health Care Costs; D006801:Humans; D007348:Insurance, Health; D001743:Urinary Bladder / Q000473:pathology*
keywords: Kosten; Routinedaten; Tiefinfiltrierende Endometriose; costs; deep infiltrating endometriosis; gesetzliche Krankenversicherung; health claims data; statutory health insurance