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1 . 2022

Demographic, social and economic effects of hormonal therapy in endometriosis and abnormal uterine bleeding

Abstract

Endometriosis and abnormal uterine bleeding (AUB) are diseases with very high prevalence which lead to serious negative outcomes. Prevalence of symptomatic endometriosis is 5% and AUB is 10% in women of 16–54 years old. One on most used method of treatment of both diseases is hormonal therapy. The goal of study is to define potentially preventable social, demographic and financial burden of endometriosis and AUB if hormonal therapy is used. Firstly, we assessed total social, demographic and financial burden from endometriosis (including related infertility) and AUB. The burden we calculated by days of absence from work [what need social payment and decrease the impact to gross domestic product (GDP)] and lower number of birth due to infertility (decrease of GDP). Then, the preventable burden due to hormonal therapy was calculated.

Potentially preventable burden from endometriosis and AUB was 93.2 bln rub. per year: 21.0 from endometriosis (due to days of absenteeism 0.65 thsd days and birth of 2.2 thsd children), and from AUB 72.2 bln rub. per year (due to days of absenteeism 4.7 mln days). However, in Russian Federation, only 24% of women with endometriosis take hormonal therapy and only 19% – with AUB. As a result, only part of burden is really prevented nowadays: 19.1 bln rub per year (5.1 bln rub. from endometriosis, including 0.3 bln rub. from infertility and 14,1 bln rub. from AUB). According to these facts, it is possible to prevent additional burden or get an additional effect of 74.0 bln rub. per year, when hormonal therapy is prescribed to all those in need of it. Return on investment, estimated through additional treatment costs, per 1 rub., it will amount to 1.34 rub. in case of endometriosis, and with AUB – 3.35 rub. The authors conclude that organizational measures should be taken to increase the number of women who are diagnosed and should be prescribed hormonal therapy for endometriosis and AUB. Among these measures: informing women, training doctors, actively identifying patients, timely diagnosis and start of therapy, follow-up on prescriptions, creating registers of women who need therapy. At the same time, it is advisable for these diseases to include hormonal therapy in the system of free provision by State on an outpatient basis, as is done in all developed countries.

Keywords:endometriosis, abnormal uterine bleeding (AUB); infertility; hormonal therapy; preventable burden from endometriosis, infertility due to endometriosis, to AUB; loss of gross domestic product; return on investment prescribing therapy

Funding. The study was carried out with the support of Abbott Laboratories LLC.

Conflict of interest. The authors declare no conflict of interest.

For citation: Ulumbekova G.E., Khudova I.Yu. Demographic, social and economic effects of hormonal therapy in endometriosis and abnormal uterine bleeding. ORGZDRAV: novosti, mneniya, obuchenie. Vestnik VSHOUZ [HEALTHCARE MANAGEMENT: News, Views, Education. Bulletin of VSHOUZ]. 2022; 8 (1): 82–113. DOI: https://doi.org/10.33029/2411-8621-2022-8-1-82-113 (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Guzel E. Ulumbekova
MD, MBA from Harvard University (Boston, USA), Head of the Graduate School of Healthcare Organization and Management (VSHOUZ)
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