Comparison of Healthcare Costs for Women with Treated Versus Untreated Vasomotor Symptoms Due to Menopause

Abstract

Introduction: The study objective was to estimate all-cause healthcare resource utilization (HCRU) and medical and pharmacy costs for women with treated versus untreated vasomotor symptoms (VMS) due to menopause.

Methods: A retrospective study was conducted using US claims data from Optum Research Database (study period: January 1, 2012-February 29, 2020). Women aged 40-63 years with a VMS diagnosis claim and ≥ 12 and ≥ 18 months of continuous enrollment during baseline and follow-up periods, respectively, were included. Women treated for VMS were propensity score matched 1:1 to untreated controls with VMS. Standardized differences (SDIFF) ≥ 10% were considered meaningful. A generalized linear model (gamma distribution, log link, robust standard errors) estimated the total cost of care ratio. Subgroup analyses of on- and off-label treatment costs were conducted.

Results: Of 117,582 women diagnosed with VMS, 20.5% initiated VMS treatment and 79.5% had no treatment. Treated women (n = 24,057) were matched to untreated VMS controls. There were no differences in HCRU at follow-up (SDIFF < 10%). Pharmacy ($487 vs $320, SDIFF 28.4%) and total ($1803 vs $1536, SDIFF 12.6%) costs were higher in the treated cohort. Total costs were 7% higher in the treated cohort (total cost ratio 1.07, 95% CI 1.05-1.10, P < 0.001). The on-label treatment pharmacy costs ($546 versus $315, SDIFF 38.6%) were higher in the treated cohort. Off-label treatment had higher medical costs ($1393 versus $1201, SDIFF 10.4%).

Conclusions: Most women with VMS due to menopause were not treated within 6 months following diagnosis. While both on- and off-label treatment increased the total cost of care compared with untreated controls, those increases were modest in magnitude and should not impede treatment for women who report symptom improvement as a result of treatment.

Keywords: Database; HCRU; Health care costs; Healthcare resources; Hormone replacement therapy; Hot flashes; Propensity score; Resource use; Retrospective studies; Treatment.

Fig. 1

Study design. HCRU, healthcare resource utilization

Fig. 2

Cohort identification. ^aOf the 24,069 treated women, 24,057 were successfully matched to 24,057 untreated controls. PS propensity score, VMS vasomotor symptoms

Fig. 3

Follow-up VMS all-cause healthcare costs,^a treated vs untreated^b post-PS-matched, USD. ^aNot shown are emergency department, inpatient, and other medical costs due to minimal counts. ^bOf the 24,069 treated women, 24,057 were successfully matched to 24,057 untreated controls. ^cStandardized differences noted are meaningful, i.e., SDIFF ≥ 10%. PS propensity score, SDIFF standardized difference, USD US dollars, VMS vasomotor symptoms

Fig. 4

Follow-up VMS all-cause healthcare costs^a by on-label^b and off-label treatment^c post-PS-matched, USD. ^aNot shown are emergency department, inpatient, and other medical costs due to minimal counts. ^bOf the 24,057 successfully matched treated cohort, 15,069 received on-label treatment and were successfully matched to 15,069 untreated controls. ^cOf the 24,057 successfully matched treated cohort, 8988 received off-label treatment and were successfully matched to 8988 untreated controls. ^dStandardized differences noted are meaningful, i.e., SDIFF ≥ 10%. PS propensity score, SDIFF standardized difference, USD US dollars, VMS vasomotor symptoms