Healthcare resource utilization and expenditures of women diagnosed with hypoactive sexual desire disorder

Figures & data

Table 1.  Demographics: all hypoactive sexual desire disorder (HSDD) vs. all controls.

	HSDD n = 2,870		Controls n = 8,610
	n/mean	%/SD	n/mean	%/SD
Mean (SD) age	42.8	10.3	42.8	10.3
Geographic region*
Northeast	225	7.8%	947	11.0%
North Central	761	26.5%	2,215	25.7%
South	1,259	43.9%	3,666	42.6%
West	580	20.2%	1,636	19.0%
Unknown	45	1.6%	146	1.7%
Plan type
Indemnity	541	18.9%	1,621	18.8%
HMO	454	15.8%	1,370	15.9%
POS	309	10.8%	931	10.8%
PPO	1,188	41.4%	3,586	41.6%
CDHP	5	0.2%	40	0.5%
Other	351	12.2%	1,002	11.6%
Missing/unknown	22	0.8%	60	0.7%
Diagnosing provider type
PCP	858	29.9%	2,574	29.9%
Specialist
OB/Gyn	1,619	56.4%	4,857	56.4%
Psychiatrist	17	0.6%	51	0.6%
Counseling	117	4.1%	351	4.1%
Other	209	7.3%	627	7.3%
Unknown/missing	50	1.7%	150	1.7%
Relationship*
Employee	1,348	47.0%	4,652	54.0%
Dependent	1,522	53.0%	3,958	46.0%
Index year
1998	59	2.1%	173	2.0%
1999	152	5.3%	457	5.3%
2000	212	7.4%	634	7.4%
2001	212	7.4%	850	9.9%
2002	461	16.1%	1,376	16.0%
2003	528	18.4%	1,590	18.5%
2004	487	17.0%	1,463	17.0%
2005	354	12.3%	1,066	12.4%
2006	334	11.6%	1,001	11.6%

*Chi-square test for differences between HSDD cases and controls is significant at p < 0.001.

SD, standard deviation; HMO, health maintenance organization; POS, point of service; PPO, preferred provider organization; CDHP, consumer driven health plan; PCP, primary care provider.

Table 2.  Clinical characteristics of women with hypoactive sexual desire disorder (HSDD) and controls in the pre-period.

	HSDD n = 2,870		Controls n = 8,610
	n	%	n	%
Correlates of female sexual dysfunction
Gynecological surgeries*	86	3.0%	93	1.1%
Pregnancy*	173	6.0%	6	0.1%
Evidence of birth control prescription*	550	19.2%	841	9.8%
Genitourinary infections*	542	18.9%	988	11.5%
Common comorbid conditions
Diabetes*	80	2.8%	388	4.5%
Anxiety*	137	4.8%	140	1.6%
Depression*	296	10.3%	379	4.4%
Thyroid abnormality	237	8.3%	620	7.2%
Cancer or history of cancer	102	3.6%	302	3.5%
Alcohol or substance abuse	14	0.5%	35	0.4%
Fibromyalgia	72	2.5%	151	1.8%
Migraine*	104	3.6%	175	2.0%
Modified Deyo–Charlson Comorbidity Index (mean, SD)	0.22	0.65	0.25	0.70
Prescription medications
Antidepressants
Selective serotonin reuptake inhibitors (SSRIs)*	548	19.1%	965	11.2%
Tricyclic antidepressants (TCAs)	97	3.4%	229	2.7%
Monoamine oxidase inhibitors (MAOIs)	0	0.0%	1	0.0%
Other antidepressants (other than bupropion)*	236	8.2%	335	3.9%
Antihypertensives*	368	12.8%	1,317	15.3%
Benzodiazopines*	341	11.9%	752	8.7%
Chemotherapy	23	0.8%	47	0.5%
Clomid	4	0.1%	18	0.2%
GnRH analogues	8	0.3%	10	0.1%
Narcotics (opiates)*	587	20.5%	1,356	15.7%
Standard of care for HSDD treatment
CNS mediated agents
Buproprion*	244	8.5%	239	2.8%
Dopamine agonists	8	0.3%	17	0.2%
Hormones
Testosterone*	244	8.5%	19	0.2%
Estrogen*	727	25.3%	1,287	14.9%
DHEA	1	0.0%	0	0.0%
Vasoactive agents	0	0.0%	0	0.0%
PDE-5 inhibitors	4	0.1%	2	0.0%

*Chi-square test for differences between HSDD cases and controls is significant at p < 0.001.

SD, standard deviation; GnRH, gonadotropin-releasing hormone; CNS, central nervous system; DHEA, dehydroepiandrosterone; PDE-5, phosphodiesterase type 5.

Table 3.  Unadjusted healthcare costs for women with and without hypoactive sexual desire disorder (HSDD) in the pre- and post-periods.

	Women with HSDD		Matched Cohort		Delta	p-value
	n = 2,870		n = 8,610
	Mean	SD	Mean	SD
Pre-period expenditures ($)
Inpatient admissions	1,157.05	6,740.99	915.33	5,746.47	241.72	0.062
Emergency room visits	125.49	556.37	109.63	770.58	15.86	0.309
Outpatient medical, office visits	395.34	514.99	270.31	395.93	125.03	<0.001
Outpatient radiology	378.20	1,344.76	270.34	1,119.58	107.86	<0.001
Outpatient medical, other*	1,913.40	4,317.15	1,521.45	5,118.24	391.95	<0.001
Outpatient behavioral health, office visits	107.50	487.49	47.32	349.60	60.18	<0.001
Outpatient behavioral health, other†	6.96	118.27	4.67	114.40	2.29	0.357
Standard of care for HSDD treatment	101.98	259.51	57.12	191.89	44.86	<0.001
All other pharmaceutical	1,051.97	2,047.65	898.21	2,211.88	153.76	0.001
Total pre-period expenditures	5,240.60	10,486.09	4,094.38	10,466.45	1,146.22	<0.001
Post-period expenditures ($)
Inpatient admissions	863.07	6,754.74	968.31	6,695.99	(105.24)	0.467
Emergency room visits	146.82	690.84	115.93	869.69	30.89	0.084
Outpatient medical, office visits	469.76	535.52	288.56	409.73	181.20	<0.001
Outpatient radiology	400.94	1,394.78	317.18	1,161.79	83.76	0.002
Outpatient medical, other*	2,063.24	4,626.76	1,765.24	6,195.58	298.00	0.018
Outpatient behavioral health, office visits	158.17	608.14	51.14	346.13	107.03	<0.001
Outpatient behavioral health, other†	6.41	82.55	3.45	92.26	2.96	0.127
Standard of care for HSDD treatment	151.97	357.83	61.87	216.90	90.10	<0.001
All other pharmaceutical	1,243.24	2,350.34	1,034.56	2,563.81	208.68	<0.001
Total post-period expenditures	5,503.62	11,132.15	4,606.24	12,600.62	897.38	<0.001

*Includes other professional visits, outpatient surgeries, laboratory, and all other outpatient services.

†Includes any service, other than office visit, provided by psychiatrist, psychologist, or counselor.

Table 4.  Comparison of utilization for the hypoactive sexual desire disorder (HSDD) cohort and matched controls during the pre-index and post-index periods.

Utilization measure	Pre-index				Post-index
	HSDD cohort	Matched controls	Difference	p-value*	HSDD cohort	Matched controls	Difference	p-value*
Number of patients	2,870	8,610	n/a	n/a	2,870	8,610	n/a	n/a
Inpatient admissions	0.10	0.07	0.03	0.0003	0.06	0.08	(0.02)	0.0081
Emergency room visits	0.22	0.21	0.01	0.7049	0.22	0.20	0.02	0.4110
Outpatient medical office visits	4.72	3.25	1.47	<0.0001	5.70	3.47	2.23	<0.0001
Outpatient radiology services	2.12	1.73	0.39	<0.0001	2.36	1.96	0.40	<0.0001
Other outpatient medical services	15.70	11.64	4.05	<0.0001	17.67	12.59	5.07	<0.0001
Outpatient behavioral health office visits	1.00	0.45	0.56	<0.0001	1.50	0.51	0.99	<0.0001
Other outpatient behavioral health services	0.07	0.04	0.03	0.1201	0.05	0.05	0.00	0.9666
Standard of care for HSDD treatment	1.63	0.93	0.70	<0.0001	2.10	0.91	1.19	<0.0001
All other pharmaceutical	14.38	11.65	2.73	<0.0001	15.96	12.91	3.05	<0.0001

*Two-sample t-test.

Table 5.  Comparison of utilization in the pre-index and post-index periods for the hypoactive sexual desire disorder (HSDD) cohort and matched controls.

Utilization measure	HSDD cohort				Matched control cohort
	Pre-index	Post-index	Difference	p-value*	Pre-index	Post-index	Difference	p-value*
Number of patients	2,870	2,870	n/a	n/a	8,610	8,610	n/a	n/a
Inpatient admissions	0.10	0.06	(0.04)	<0.0001	0.07	0.08	<0.01	0.5826
Emergency room visits	0.22	0.22	0.00	1.0000	0.21	0.20	(0.01)	0.5380
Outpatient medical office visits	4.72	5.70	0.98	<0.0001	3.25	3.47	0.22	<0.0001
Outpatient radiology services	2.12	2.36	0.24	0.0094	1.73	1.96	0.23	<0.0001
Other outpatient medical services	15.70	17.67	1.97	<0.0001	11.64	12.59	0.95	<0.0001
Outpatient behavioral health office visits	1.00	1.50	0.50	<0.0001	0.45	0.51	0.06	0.0222
Other outpatient behavioral health services	0.07	0.05	(0.01)	0.6191	0.04	0.05	0.01	0.4162
Standard of care for HSDD treatment	1.63	2.10	0.47	<0.0001	0.93	0.91	(0.01)	0.5078
All other pharmaceutical	14.38	15.96	1.58	<0.0001	11.65	12.91	1.25	<0.0001

*Paired t-test.

Table 6.  Regression results for pre-period costs.

Explanatory items (measured at index)	Relative cost compared to absence of item	Lower 95% CI	Upper 95% CI	p-value
HSDD vs. controls	1.13	1.07	1.19	<0.0001
Diabetes	1.97	1.78	2.19	<0.0001
Thyroid abnormality	1.34	1.24	1.44	<0.0001
Chemotherapy	3.15	2.43	4.08	<0.0001
Cancer diagnosis	2.18	1.95	2.43	<0.0001
Fibromyalgia	1.41	1.22	1.63	<0.0001
Migraine	1.10	0.96	1.25	0.1596
Anxiety diagnosis	1.03	0.90	1.17	0.711
Depression diagnosis	1.29	1.18	1.42	<0.0001
Substance abuse	1.32	0.97	1.80	0.0767
SSRI	1.35	1.26	1.44	<0.0001
Other antidepressant	1.51	1.39	1.63	<0.0001
Benzodiazepine	1.27	1.18	1.37	<0.0001
Narcotics	2.11	1.99	2.23	<0.0001
GnRH analogues	1.83	1.11	3.03	0.0185
Clomid	1.56	0.99	2.45	0.0564
Antihypertensives	1.70	1.60	1.81	<0.0001
Gyn surgery	3.05	2.60	3.59	<0.0001
Genitourinary infection	1.40	1.32	1.49	<0.0001

Generalized linear model with gamma-distributed error and log link.

Goodness of fit assessed by comparing deviance and degrees of freedom to asymptotic chi-square (p = 0.24).

SSRI, selective serotonin reuptake inhibitors; GnRH, gonadotropin-releasing hormone; Gyn, gynecological.

Table 7.  Regression results for post-period costs.

Explanatory items (measured at index)	Relative cost compared to absence of item	Lower 95% CI	Upper 95% CI	p-value
HSDD vs. controls	1.17	1.11	1.24	<0.0001
Diabetes	1.83	1.64	2.05	<0.0001
Thyroid abnormality	1.27	1.17	1.38	<0.0001
Chemotherapy	3.16	2.39	4.17	<0.0001
Cancer diagnosis	2.25	2.00	2.54	<0.0001
Fibromyalgia	1.45	1.24	1.70	<0.0001
Migraine	1.25	1.08	1.44	0.0023
Anxiety diagnosis	0.97	0.84	1.12	0.6637
Depression diagnosis	1.25	1.13	1.38	<0.0001
Substance abuse	1.12	0.81	1.55	0.5002
SSRI	1.20	1.12	1.29	<0.0001
Other antidepressant	1.39	1.27	1.52	<0.0001
Benzodiazepine	1.42	1.31	1.54	<0.0001
Narcotics	1.30	1.22	1.38	<0.0001
GnRH analogues	1.80	1.04	3.09	0.0346
Clomid	2.16	1.33	3.53	0.002
Antihypertensives	1.54	1.45	1.65	<0.0001
Gyn surgery	0.95	0.80	1.14	0.5994
Genitourinary infection	1.24	1.16	1.32	<0.0001

Generalized linear model with gamma-distributed error and log link.

Goodness of fit assessed by comparing deviance and degrees of freedom to asymptotic chi-square (p = 0.26).

SSRI, selective serotonin reuptake inhibitors; GnRH, gonadotropin-releasing hormone; Gyn, gynecological.