Trends in Endometriosis Management: A 10-Year US Claims Analysis

Area of Science:

• Reproductive Medicine
• Health Services Research
• Pharmacoeconomics

Background:

• Endometriosis affects millions of women, causing significant pain and impacting quality of life.
• Clinical guidelines recommend specific treatment pathways for endometriosis management.
• Real-world adherence to these guidelines is not well-documented.

Purpose of the Study:

• To analyze current treatment patterns for endometriosis in the United States.
• To assess the concordance of observed treatments with clinical best practices.
• To investigate the sequence and timing of interventions for endometriosis.

Main Methods:

• Retrospective observational study utilizing data from two large US health insurance claims databases (MarketScan® and OPTUM®) from 2009-2022.
• Inclusion criteria: Women aged 16-45 with at least two endometriosis diagnoses and continuous enrollment.
• Analysis included treatment frequencies, initiation times, and sequences using Kaplan-Meier curves and Sankey diagrams.

Main Results:

• Over 76,000 women were analyzed; surgery was the most common intervention (71-72%), often as first-line treatment (37-41%).
• Pharmacological therapy was used first-line in 45-49% of patients, with opioids frequently prescribed initially (12-13%).
• Treatment initiation occurred within 4-6 months of diagnosis, with shorter intervals for those with gynecologic comorbidities.

Conclusions:

• Endometriosis treatments are initiated within 4-6 months of diagnosis, with surgery frequently employed as the primary intervention.
• The prevalent use of opioids as a first-line therapy contradicts clinical guidelines.
• Further research is needed to align real-world endometriosis treatment with evidence-based recommendations.