Endometriosis treatment pathways in the largest private health insurance in Brazil: A real-world data study

Abstract

Introduction Endometriosis is a prevalent chronic gynecological condition affecting women of reproductive age, characterized by ectopic endometrial-like tissue growth. Despite its significant impact on quality of life, fertility, and healthcare utilization, data on real-world treatment pathways in Brazil remain scarce. Objective This study explores the clinical and demographic characteristics, diagnostic timelines, and treatment outcomes for women undergoing surgical treatment for endometriosis within Brazil’s largest healthcare database. Methods A retrospective cohort study was conducted using data from over 8.8 million lives within the Hapvida NotreDame portfolio. Women undergoing their first surgical procedure for endometriosis between 2006 and 2024 were included. Data on clinical characteristics, healthcare utilization, symptoms, and costs were analyzed. Results The cohort included 5,740 women, with a median surgical age of 37 years. We found that patients with deep endometriosis took longer to undergo surgery than those with superficial endometriosis. Following surgery, there was an increase in the number of normal deliveries and cesarean sections, along with a decrease in the number of emergency gynecological consultations. The median hospital stay for surgery was 1 day and only 66 (1.1%) patients required postoperative ICU care. Additionally, 93 (1.6%) of the patients needed early reoperation, and 239 (4.1%) experienced disease recurrence and required further surgery. The surgery for patients with deep endometriosis was 40% more expensive than for those with superficial endometriosis, and the cost of diagnostic exams for the disease was equivalent to 69% of the cost of the first surgery for endometriosis. Conclusions This study provides critical insights into the real-world burden of endometriosis, emphasizing the importance of timely diagnosis and surgical intervention. The findings underline the potential for improved quality of life and healthcare utilization through optimized care pathways and resource allocation.