OBJECTIVES: During menopause, 60%–80% of US women experience vasomotor symptoms (VMS) associated with menopause and may receive on-label or off-label treatments. We compared total cost of care (TCC) of treated vs untreated VMS.

METHODS: This retrospective study included data from commercial and Medicare Advantage beneficiaries with ≥1 claim containing diagnosis codes for natural or surgical menopause and menopausal climacteric state or flushing or hyperhidrosis from 01/01/13-09/01/18. Treated patients had ≥12 months of continuous benefits enrollment at the index date (first VMS diagnosis claim date) and received systemic hormone therapy or paroxetine 7.5 mg (on-label) or off-label treatments including selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, gabapentin, pregabalin, clonidine, oxybutynin, or compounded estradiol pellet. Treated and untreated patients were propensity-score matched. TCC (medical+pharmacy), and net costs of VMS treatment were compared using standardized differences (SDIFFs) and robust generalized linear model.

RESULTS: Of 117,582 eligible women, 15,077 (12.8%) received on-label and 8992 (7.6%) received off-label treatment; 93,513 (79.5%) were untreated. Post-matched sample (n=48,114) was balanced by baseline Charlson comorbidity scores (0.20 [0.56]; SDIFF=0.0%) and TCC (SDIFF=2.1%; medical=2.7%, pharmacy=1.4%). During 12 months post-index, treated vs untreated TCC ratio was 1.18 for on-label ($1816 [$2050] vs $1541 [$2288]; SDIFF=12.6%; P<0.001) and 1.17 for off-label ($1781 [$2100] vs $1528 [$1903]; SDIFF=12.7%; P<0.001) treatment. Differences were greater for pharmacy costs on-label (SDIFF=38.6%) vs off-label (SDIFF=10.8%) treatment. Excluding VMS medication costs, TCC ratio was 1.03 for on-label ($1582 [$2024] vs $1529 [$2284]; SDIFF=2.5%; P=0.03) and 1.13 for off-label ($1721 [$2089] vs $1517 [$1899]; SDIFF=10.2%; P<0.001) treatment.

CONCLUSIONS: Most patients were untreated; VMS treatment was associated with higher TCC. Pharmacy costs drove on-label treatment costs, whereas medical costs drove off-label treatment costs. Unmeasured confounders, including VMS severity and frequency, that may affect costs warrant further research.