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

Abstract

Study objective: To examine real-world treatment patterns for endometriosis and their alignment with clinical best-practice recommendations.

Design: Observational, retrospective study from 2009 to 2022.

Setting: Two large US health insurance claims databases, MarketScan® and OPTUM®.

Patients: Women aged 16-45 years with continuous enrollment in OPTUM® and MarketScan® and at least 2 diagnoses of endometriosis. Hysterectomy, menopause or active treatment of malignancy were exclusion criteria.

Interventions: Pharmacological therapy (including OCPs, POPs, GnRH analogs, opioids), and surgical management (including laparoscopy and hysterectomy).

Measurements: Frequencies, means, Time-to-event Kaplan-Meier curves, and Sankey diagrams were used to examine treatment initiation, frequencies and sequences.

Main results: A total of 22,317 participants from OPTUM® and 54,630 from MarketScan® were included. Most of these patients (71.0% OPTUM®, 72.1% MarketScan®) received surgery after diagnosis of endometriosis, whereas medications were prescribed in 42.1% (OPTUM®) and 44.9% (MarketScan®). Surgery was performed as a first-line intervention in 37.6% (n=8,395, including 4,481 laparoscopies and 3,914 hysterectomies in OPTUM®) and 41.8% (n=22,858, including 13,175 laparoscopies and 9,683 hysterectomies in MarketScan®). Among first-line surgeries (n=8,395 OPTUM®, n=22,858 MarketScan®), laparoscopies accounted for over half (53.4%, n=4,481 OPTUM®; 57.6%, n=13,175 MarketScan®), while hysterectomies comprised nearly half (46.6%, n=3,914 OPTUM®; 42.4%, n=9,683 MarketScan®). Pharmacotherapy was used first-line in 49.9% (n=11,135) of OPTUM® and 45.5% (n=24,840) of MarketScan®. Opioids were used first-line in 12.5% (n=2,787) OPTUM® and 12.7% (n=6,932) MarketScan®. Pharmacological therapies were started as first-line intervention within 15-23 weeks, and surgeries were performed within 16-18 weeks after diagnosis. Those with gynecologic comorbidities had a shorter diagnosis-to-treatment interval than those with mental health and pain comorbidities.

Conclusion: Therapies for endometriosis are generally started within 4-6 months of diagnosis. Surgery is used more frequently than medical management, and in the majority of cases, surgery was first-line intervention. Opioids are still frequently prescribed despite strong guidelines recommending against their use.