Endometrioosiga naiste ravisündmused ja ravikulud aastatel 2012–2019

Abstract

Endometriosis is a chronic inflammatory condition in which tissue similar to the lining of the uterus grows outside the uterus, causing pain, adhesions, cysts, and often infertility. It affects approximately 1–10% of women of reproductive age and is difficult to diagnose due to its nonspecific symptoms, frequently leading to years of diagnostic delay. Treatment focuses on symptoms, but therapeutic options often have limited efficacy. The societal costs associated with endometriosis are substantial and comparable to those of other chronic illnesses. To date, there has been limited research on real-world healthcare utilisation and costs among women with endometriosis, particularly in comparison to women without the diagnosis. There is also insufficient evidence on how the diagnosis itself alters treatment pathways and expenditures, or when disease-specific symptoms first emerge over time. This study used electronic health data covering 10% of the Estonian population from 2012 to 2019. A cohort of women diagnosed with endometriosis (n = 631) was compared to an age-matched control cohort (n = 3780) without an endometriosis diagnosis. Healthcare events and costs were analysed using R packages developed for the OMOP common data model, along with supplementary SQL and R scripts. The results showed that women with endometriosis had a higher risk of infertility, abdominal pain, and reproductive organ-related conditions. They underwent more surgeries and diagnostic procedures, and used more hormone therapies and other medications. Most symptoms associated with endometriosis began before the initial diagnosis—often years earlier. Over a four-year period, the average healthcare costs for women with endometriosis were 1.7 times higher than for those in the control cohort. The mean per-person cost was €3411 in the endometriosis cohort and €1973 in the control cohort. Longer-term follow-up data are needed to investigate the earlier onset of symptoms and to more precisely estimate the total economic burden of the disease.