Insurance companies, medical societies, the government, scientists, researchers and, yes, patients often look at the cost of medical disorders and problems as well as that of the therapy to treat or prevent them. Does a disease or troublesome symptoms cause a decrease in life span, health span or life quality? Does it impact a person’s ability to live productively? (i.e.. make a living and support a family). Does the economy suffer, and how much does it cost (in real money, not just ethically) to treat or prevent a disorder or symptoms that impact the work force?
The economic impact of menopausal symptoms was addressed in a recent article in the Journal, Menopause entitled, “Incremental direct and indirect costs of untreated vasomotor symptoms.” The authors from the Department of Obstetrics and Gynecology at Yale, the Columbus Center for Women’s Health Research in Ohio, and an analytic group from Montreal, Canada as well as Noven Pharmaceuticals Inc, New York (yes a pharmaceutical company, I assume they helped provide the financing for study) gathered health insurance claims between 1999 and 2011 and matched the productivity and health care utilization of women who had vasomotor symptoms and those who did not.
Just to remind you, vasomotor symptoms (VMS) includes hot flashes, night sweats, vaginal dryness and (to add insult to injury) these are frequently accompanied by other symptoms including disturbed sleep, feeling anxious and depressed, irritability, difficulty concentrating and impaired short-term memory. In this study, 252,273 women with VMS were matched with the same number of women without VMS. They were the same age, were living in the same region and had the same type of insurance. The database included medical and pharmacy claims for individuals covered by 60 self-insured fortune 500 companies in the United States.
The results were quite astounding: Those women who were not treated for their VMS had a significantly higher need for health care utilization, had greater work loss and cost burden. The women with VMS incurred 82% higher all-cause outpatient visits and 121% more VMS related visits to their doctors. This meant that, according to their calculations, the mean direct cost per patient per year was $1346 more for women with VMS compared to those who had no symptoms. Additionally women with VMS had 57% more indirect work productivity lost days than controls and this corresponded to an indirect cost per patient per year of $770.
Up to 75% of women have vasomotor symptoms once they become menopausal and more than 90% of women develop symptoms after surgical menopause. The authors discuss the fact that as a consequence of a steep decline in hormone therapy after the Women’s Health Initiative in 2002 the number of women who stopped or did not start any type of hormone therapy dropped abruptly. At the same time, there’s been an increase in the number of working women. The US Bureau of Labor statistics has reported that in the 55 years or older group of women, 68 million women (or half of the total workforce) worked either full-time or part-time in 2011 and that by 2018 more than 2 million women aged 65 to 74 could be working. The data that was collected in this study indicates that the high work absenteeism and indirect cost associated with the VMS may have a direct impact not only on women but on the economy and the workforce.
There’s no question that there is a need to understand the pros and cons of hormone therapy for what many think are just “pesky hot flashes”. VMS symptoms can cause major loss of workdays, productivity and healthcare costs. In an editorial in the same journal, there is a sentence that summarizes what I and so many women’s health physicians try to do… “Large numbers of women in the workplace need to be educated about current scientific findings on hormonal and non-hormonal therapies so that effective individualized care can be developed to improve quality-of-life and to decrease the VMS related health costs and loss of workdays and productivity.”