Benign pelvic conditions are associated with increased healthcare costs as well as associated concurrent pelvic conditions, but the extent has not been fully characterized[1]. In this study we present insurance data inclusive of all diagnoses and charges for one year, including pharmacy, behavioral health, and emergency visits. We hypothesize that there is a significant cost associated with treating patients with pelvic floor dysfunction and an increased correlation with additional pelvic symptoms.

Deidentified 12-month 2022-2023 data from a northeastern private insurer covering teachers and municipal workers was queried across 19 pelvic diagnoses and associated ICD-10 codes: bladder (N39.0, N32.81, R33.9, Z87.440, N40.1), bowel (K58.9, K59.00, K59.02, R15.9), pelvic floor muscle abnormalities (M62.838, M62.89, N94.89), pelvic pain (N30, N50.81, N50.82, N94.89, R10.2), sexual dysfunction (N52.9, N94.1), as well as endometriosis (N80) and 7 relevant neurological diagnoses (G35, G62.9, G82.20, G82.50, G96.191, I63.9, M54.17). Binary logistic regression, chi-squared and ANOVA were utilized to determine associations.

The database included all 4306 members. Average annual cost per member was $9,280, average age was 35.5 years, and 53% were female. Twenty five percent (25%) of members (1079) had a benign pelvic diagnosis, which increased average cost per member to $18,980.  

The most frequent pelvic symptoms were bladder, followed by pelvic pain, musculoskeletal, bowel, and sexual symptoms 46.3%, 23.5%, 21.4%, 11.6%, and 8.4% respectively of those with pelvic symptoms, and 13.7%, 7.0%, 6.4%, 3.4%, and 2.5% of the entire population respectively. Neurologic diagnoses relevant to pelvic health were present in 304 patients (7.1% of the membership) and endometriosis in 70 (1.62%). 

Associations of one pelvic symptom were observed with the others. Of the 592 patients with bladder symptoms, 377 (63.7%) had one additional pelvic symptom, 165 (28%) had two, 40 (6.8%) had three, and 10 (1.7%) had four (Chi-square = 285.4, p value < 0.001). Of the 301 patients who had pelvic pain, 139 (46%) had one additional pelvic symptom, 117(39%) two, 36 (12%) had three, and 9 (3%) had four (Chi-square = 285.7, p value < 0.001). Of the 274 patients who had MSK symptoms, 165 (60%) had one additional pelvic symptom, 64 (24%) had two, 35 (12.8%) had three, and 10 (3.7%) had four (Chi-square = 183.6, p value < 0.001). Of the 148 patients who had bowel symptoms, 80 (54%) had one additional pelvic symptom, 46 (31%) had two, 15 (10.1%) had three, and 7 (4.7%) had four (Chi-square = 100, p value < 0.001). Of the 304 patients who had neurological symptoms relevant to the pelvis, 91 (30%) had one pelvic symptom, 42 (14%) had two, 6 (2%) had three, and 3 (1%) had four additional pelvic symptoms (Chi-square = 432, p value < 0.001). Endometriosis did not have a significant relationship. 

In those with bladder diagnoses, 6.7% had bowel diagnoses (Chi-square = 24.9, p value < 0.001), 11.8% had MSK diagnoses (Chi-square = 60.1, p value < 0.001), 18.4% had pelvic pain (Chi-square = 16.0, p = < 0.001), 14.2% had neurological diagnoses (Chi-square = 55.6, p value < 0.001), and 3.7% had endometriosis ( Chi-Square 6.5, p = 0.01). In those with bowel diagnoses, 4% had sexual symptoms (Chi-square = 4.1, p value = 0.04), 14.9% had MSK diagnoses (Chi-square = 4.3, p value = 0.039), and 13.5% had neurological diagnoses (Chi-square = 9.7, p value < 0.001). In those with sexual diagnoses 5% had pelvic pain (Chi-square=6.08, p value=0.014), 5.6% had endometriosis (Chi-square = 0.002, p value=0.967), 8.3% had MSK diagnoses (Chi-square = 12.0, p value=0.001), and 6.3% had neurological diagnoses (Chi-square= 2.47, p value=0.116). In those with pelvic pain, 13% had neurological diagnoses (Chi-square = 25.3, p value < 0.001, 5% had sexual diagnoses (Chi-square = 6.1, p value = 0.014), 9.6% had endometriosis (Chi-square = 13.2, p value <0.001). In those with MSK diagnoses, 15.7% had neurological diagnoses (Chi-square = 12.5, p value <0.001). 8% of patients with MSK symptoms had endometriosis (Chi-square = 4.4, p value = 0.04). 3% of patients with neurological diagnoses reported endometriosis (Chi-square = 4.9, p value = 0.028) (Table 1).

The annual healthcare cost for members was an average of $9,280 per member. Patients with only a neurological diagnosis or endometriosis without other pelvic diagnoses had mean annual expenditure of $19,767 (SD±$42,496 (n=201), For those with one pelvic symptom classes, the mean annual cost was $14,784 (SD±$44,554 (n=800)); for two pelvic symptom classes $25,455 (SD±$49,143 (n=224)); for three $44,003 (SD± $79,293 (n=45)) for four $96,959 (SD±$134,896 (n=10)). F value = 12.3, p value < 0.001 (Figure 1).

In this young working population of average age 35.5, multifactorial pelvic diagnoses were common and costly. Having just one pelvic diagnosis was associated with significantly increased annual expenditure versus the average member. Presence of one class of pelvic diagnosis increased the likelihood of having another, and each additional pelvic diagnosis increased the annual cost of care significantly.

Benign pelvic floor disorders are common, even in young populations, frequently multifactorial, and costly. The observed high health care utilization in this population implies symptomatology disruptive enough to drive high-cost care utilization (e.g. diagnostics) and non-resolution of symptoms. The multifactorial nature of pelvic health problems warrants insurance and institutional support of multidisciplinary evaluation to target improved quality of life outcomes.

Huang G, Le AL, Goddard Y, James D, Thavorn K, Payne M, Chen I. A Systematic Review of the Cost of Chronic Pelvic Pain in Women. J Obstet Gynaecol Can. 2022 Mar;44(3):286-293.e3. doi: 10.1016/j.jogc.2021.08.011. Epub 2021 Sep 26. PMID: 34587539

Continence 12S (2024) 101423
DOI: 10.1016/j.cont.2024.101423