Indirect costs of Endometriosis a Systematic review

Abstract

Endometriosis is a chronic, inflammatory disease faced by women of reproductive age, that can lead to significant losses in the quality of life. Although the direct medical costs of endometriosis have been widely studied, the indirect costs remained underresearched. This systematic review aimed to evaluate whether indirect costs are major contributors to the economic burden of endometriosis and to compare how costs vary between different countries. A secondary aim was to identify methodological issues relevant to future research in Kazakhstan. A systematic review of primary studies was conducted in accordance with PRISMA principles. PubMed and Web of Science were searched using terms related to endometriosis and indirect costs. Studies were eligible if they included women with clinically diagnosed endometriosis and reported absolute cost estimates. Eight studies left after the full text screening. Data were extracted on study design, country, sample, indirect cost components, and reported cost estimates. Risk of bias was assessed using JBI critical appraisal tools. A narrative synthesis was performed without meta-analysis. The included reports resulted in studies in high-income countries only. Across studies, indirect costs constituted 50% to 75% of total costs. Absenteeism, presenteeism, and general productivity loss were the key components. Reported annual indirect costs ranged from USD 2,400 in Germany to Int$ 17,484 in Australia. Most studies were of moderate quality and moderate risk of bias. Overall, the evidence consistently shows that indirect costs are a substantial contributor to the economic burden. The review has identified a significant research gap in the standardized research methodologies and the lack of evidence in the LMIC. The findings suggest that even though the exact productivity loss from endometriosis is difficult to measure, the condition must not be underprioritized to decrease societal and economic burden.