OBJECTIVES: Endometriosis is a chronic gynecologic disorder associated with long diagnostic delays due to delayed referrals and misdiagnoses. This study examined economic impact of diagnostic delays on pre-diagnosis healthcare costs among endometriosis patients.

METHODS: Commercially insured patients ages 18-49 from the Optum Research Database™ with ≥1 claim with ICD-9/10-CM diagnosis code for endometriosis during 01Jan2004-31Jul2016 were selected (date of earliest claim=index/diagnosis date). Inclusion criteria were continuous health plan enrollment for 60 months pre-index and 12 months post-index, and ≥1 pre-index claim for an endometriosis symptom (dyspareunia, generalized pelvic pain, abdominal pain, dysmenorrhea, infertility). Patients with pre-index claims for endometriosis, malignancies, or conditions with similar symptomology to endometriosis were excluded. Diagnostic delays, defined as time from earliest claim for symptom to index date, were used to assign patients to a cohort: delay ≤1 year (short), 1-3 years (intermediate), and 3-5 years (long). All-cause and endometriosis-related costs (costs of endometriosis symptoms, endometriosis-related procedures and medications) were measured over 5-year baseline and compared between cohorts using t-tests.

RESULTS: Out of 11,793 patients (mean age 39.3±7.4) selected, 4,446 were in short-delay, 3,179 in intermediate-delay, and 4,168 in long-delay cohorts. Most common symptoms were abdominal pain (67%), dysmenorrhea (52%), and dyspareunia (13%). Mean diagnostic delay was 763.9 ± 631.0 days. Pre-diagnosis all-cause healthcare costs increased with longer diagnostic delay: long-delay cohort had 60% and 15% higher mean total costs than short- and intermediate-delay cohorts ($34,459.8, $21,489.3 and $30,030.0 respectively; p<0.001), driven primarily by higher medical costs (p<0.001). Mean pre-diagnosis endometriosis-related costs were higher in intermediate- and long-delay cohorts ($3,982.2 and $4,793.8; respectively) compared with short-delay cohort ($2,081.8) (p<0.001).

CONCLUSIONS: Endometriosis patients with longer diagnostic delays may have a greater economic burden before diagnosis due to significantly higher healthcare costs. Minimizing diagnostic delays by employing more efficient diagnostic paradigms could benefit both patients and healthcare system.