Current practice patterns for management of vulvodynia in the United States.

ABSTRACT

PURPOSE: To evaluate the current practice patterns for the management of vulvodynia in the United States (US) and to estimate healthcare costs related to this condition. METHODS: Truven MarketScan Commercial Claims and Encounters databases for years 2009-2013 were utilized for analysis. The study cohort included women, 18 years or older, with a diagnosis of vulvodynia (ICD-9 625.70), who had been continuously enrolled for 360 days from the date of diagnosis. Measures included the most common prescriptions, primary procedures, associated diagnoses, as well as net healthcare costs. Statistical Analysis Software 9.3 was used for statistical analysis. RESULTS: Among 24,122 subjects with vulvodynia, 12,584 met enrollment criteria. Mean age was 41.0 ± 12.9 years. Vulvar biopsy (29.6%), urinalysis (27.8%), urine culture (27.5%) and wet mount for infectious agents (25.5%) were commonly performed primary procedures. The most common prescriptions were antidepressants (32.4%), followed by opiates (27.6%), antifungals (26.1%), and steroidal agents (22.7%). Vulvodynia was frequently associated with vulvovaginitis (32.0%), urinary tract infection (20.6%), and chronic fatigue (18.6%). The mean net cost per patient including pharmacy claims during the follow-up period was $9591.80 (SD $14,595.52; 95% CI $9333.45-$9850.13). CONCLUSIONS: Our findings confirm great variation in the current management of vulvodynia. The variety of treatment approaches is a reflection of the poor current understanding of the etiology and pathophysiology of vulvodynia. Further research is needed to determine which treatments are most effective in the management of each subtype of vulvodynia.