PSUN128 Insurance Database Analysis of Healthcare Utilization by Women with PCOS
Authors: Lawrence Rebecca , Dunaif Andrea , Agarwal Parul 
Published: November 2022

Abstract
Polycystic ovary syndrome (PCOS) is among the most common disorders of premenopausal women, affecting up to 15% of this population. It has substantial reproductive and metabolic morbidities with healthcare costs of ∼$8 billion annually in the US alone. Despite its high prevalence and public health impact, PCOS diagnosis is frequently delayed and requires visits to multiple providers. Not surprisingly, patients are very dissatisfied with the care that they receive. Improving the diagnosis and management of PCOS will require an understanding of the patterns of healthcare utilization among affected women so that appropriate specialists can be targeted for educational initiatives. This information may also provide "real world" insight into the medical issues for which these patients seek care. We used an employer-sponsored commercial insurance database comprised of 26,146,275 subjects (ages 0-65 years, 48.3% female) representative of all United States regions to associate ICD-10-CM codes with specialists. Women were designated as having PCOS using a previously validated algorithm (positive predictive value 98%) of the ICD-10-CM diagnosis codes for PCOS or for hirsutism in combination with the codes for irregular menses. Women were designated as controls if they lacked ICD-10-CM codes for PCOS, ovarian hyperfunction, androgen excess, hirsutism, infertility, acne, menstrual disorders, or alopecia. The percentage of patients with ≥1 office visit to a given provider in the year 2017 was calculated. Between group comparisons were made using chi square where p&lt;0. 01 was significant. Of 9,628,264 women ages 18-40 years, 101,380 (1.1%) fulfilled criteria for PCOS and 3,460,541 fulfilled criteria for controls (35.9%). Significantly greater percentages of PCOS cases compared to controls (all P&lt;0. 001) had ≥1 visit to an endocrinologist (17. 0% vs 2.2%), an OB/GYN (66.4% vs 40.3%), a dermatologist (14.1% vs 7.8%), a psychiatrist (5.2% vs 3.7%), a cardiologist (7.4% vs 3.8%), a family medicine physician (50.5% vs 42.5%), or an internal medicine physician (29.6% vs 19. 0%). More PCOS cases (80.1%) saw family medicine and internal medicine physicians (PCPs) than controls (61.5%, PIt is not surprising, given the common symptoms of PCOS of irregular menses, hirsutism and acne, that more PCOS cases than controls had care provided by specialists in OB/GYN, endocrinology and dermatology. The higher percentage of care provided by psychiatrists is consistent with the reported increased prevalence of anxiety and depression among affected women. The increased percentage of care by cardiologists is surprising in this population of young women and supports the suggestion that PCOS is associated with premature cardiovascular disease. Our results suggest that efforts to improve provider awareness of PCOS should target PCPs. Specialist educational initiatives should include psychiatry and cardiology, in addition to the specialists providing care for the common reproductive manifestations of PCOS.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.