The economics of endometriosis
March is the international awareness month for endometriosis, also known as EndoMarch. What’s that, you might ask? Endometriosis is a chronic health condition where cells similar to the ones that form the endometrium – the inner lining of the uterus – grow outside of it. In simple terms, endometriosis is a painful disorder that 1 in 10 women in reproductive age suffers from.
The symptoms of endometriosis can vary from dysmenorrhea, abnormal pelvic pain, abnormal bleeding, to depression resulting from dealing with endometriosis-related pain and infertility. To deal with the painful symptoms, and with endometriosis overall, there are treatments that a woman can have, either pharmacological or surgical, or even both. The treatments are associated with the direct costs of endometriosis. But are these the only costs of this health condition? The answer is definitely no.
The average time to diagnose endometriosis is 7.5 years. Until the time a woman receives treatment, pain can prevent her from doing her everyday activities, socialising or working. This means that endometriosis is also associated with indirect costs, such as reduced productivity, income loss and lower quality of life.
Prast et al. (2013), using hospital data from Austria, estimated that productivity losses due to endometriosis amount to around €90 million a year. Evidence from the US showed that women aged 18-50 were absent from work for 178 hours a year due to chronic-pelvic pain, which is the most common symptom of endometriosis (Mathias et al., 1996). These hours were equal to the loss of a month of productivity on average, equivalent to a $1,700 loss of output. A more recent US study showed that women with endometriosis lost an average of 5.3 work hours a week due to reduced productivity while at work (presenteeism) and 1.1 work hours a week due to not going to work (absenteeism) (Soliman et al., 2017).
A cross-country study showed that endometriosis resulted in 10.8 lost hours of weekly work, out of which 6.4 hours were lost due to presenteeism and 4.4 hours per week lost due to absenteeism (Nnoaham et al., 2011). Lost work productivity costs per woman per week were estimated from $4 in Nigeria to $456 in Italy.
Endometriosis has also a negative effect on the quality of life of women diagnosed with it. The same cross-country study, using data on health-related quality of life (HRQoL), found that women with endometriosis had lower HRQoL scores than women with no endometriosis. Another multi-country study estimated that endometriosis generated 0.809 quality-adjusted life years (QaLY) per woman per year. This means that women suffering from this health condition have a reduction in their quality of life by 19% compared to a healthy person (Simoens et al., 2012). These results are consistent with the evidence produced from another study in Belgium, which showed that women with endometriosis-associated symptoms generated 0.82 QaLY (Klein et al., 2014). Given the current HM Treasury Green Book valuation of a QALY being equivalent to around £60k in utility (wellbeing) on a willingness-to-pay basis, the annual loss of 18-20% of this value would, in aggregate, far exceed productivity losses in the UK.
So, endometriosis affects women’s lives. A lot. How can this change? The time to diagnose endometriosis should be reduced, and this can only be achieved by improving diagnostic methods. Until then, the only thing that we can do is to help spread awareness by educating ourselves (or others), sharing our stories, or writing a blog post!