Management of endometriosis: Toward value-based, cost-effective, affordable care
Open accessAbstract
Endometriosis management seems to be influenced by outcome-independent biomedical, pharmacological, and technological developments. The propensity towards doing more affects several aspects of care, sometimes translating into proposals that are not based on sound epidemiological principles and robust evidence. Different stakeholders share the interest for doing more testing and using novel and costly drugs or devices in patients with endometriosis. Although some women may benefit from such an approach, the majority do not, and some may be harmed. Moreover, an uncontrolled increase in expenditures for endometriosis management without demonstrated and proportional health benefits would waste the finite resources of national health care services and would risk cost-related non-adherence. Cost-effectiveness analyses should be systematically pre-planned in future trials on endometriosis, and the concept of "value" of medical interventions should guide investigators and health care policymakers. Reducing low-value care, financial toxicity, and the burden of treatment is respectful not only of endometriosis patients, but also of the entire society. Whenever possible, long-term therapeutic strategies should be tailored to each woman's needs, and high-value tests and treatments should be chosen based on her priorities and preferences. Moreover, listening to patients, understanding their concerns, avoiding disease labelling, explaining plainly what is known and what is unknown, and giving constant reassurance and encouragement may be exceedingly important for the successful management of endometriosis and may change the patient's perception of her clinical condition. Physician empathy has no untoward effects, does not cause harms, and may determine whether a woman successfully copes or desperately struggles with her disease during reproductive life.
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Morelli, L., Perutelli, A., Palmeri, M., Guadagni, S., Mariniello, M. D., Franco, G. D., Cela, V., Brundu, B., Salerno, M. G., Candio, G. D., et al. (2015) · International Journal of Colorectal Disease · doi:10.1007/s00384-015-2477-2 · Cited by 53 · see citing works
Tucci, C. D., Feliciantonio, M. D., Galati, G., Verrelli, L., Donato, V. D., Marchetti, C., Panici, P. B., & Muzii, L. (2016) · Seminars in Reproductive Medicine · doi:10.1055/s-0036-1597126 · Cited by 53 · see citing works
Morelli, M., Sacchinelli, A., Venturella, R., Mocciaro, R., & Zullo, F. (2013) · Journal of Obstetrics and Gynaecology Research · doi:10.1111/jog.12030 · Cited by 52 · see citing works
Hennessy, D. A., Sanmartin, C., Ronksley, P. E., Weaver, R., Campbell, D., Manns, B., Tonelli, M. A., & Hemmelgarn, B. R. (2016) · PubMed · Cited by 52 · see citing works
Medical journals and industry ties
Chew, M., Brizzell, C., Abbasi, K. A., & Godlee, F. (2014) · BMJ · doi:10.1136/bmj.g7197 · Cited by 51 · see citing works
Is mild endometriosis a disease:Endometriosis does not exist; all women have endometriosis
Evers, J. L. H. (1994) · Human Reproduction · doi:10.1093/oxfordjournals.humrep.a138421 · Cited by 51 · see citing works
Flagged first, then by citations
1 of the 298 references couldn’t be matched to a known paper.
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Medical treatment of endometriosis-related pain
Vercellini, P., Buggio, L., Frattaruolo, M. P., Borghi, A., Dridi, D., & Somigliana, E. (2018) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2018.01.015 · Cited by 188 · see citing works
Self-citationDonnez, J., & Dolmans, M.-M. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10051085 · Cited by 182 · see citing works
Vercellini, P., Viganò, P., Buggio, L., Makieva, S., Scarfone, G., Cribiù, F. M., Parazzini, F., & Somigliana, E. (2018) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2018.01.017 · Cited by 80 · see citing works
Self-citationWhen more is not better: 10 ‘don’ts’ in endometriosis management. An ETIC* position statement
Club, E. E. T. I., Alio, L., Angioni, S., Arena, S., Bartiromo, L., Bergamini, V, Berlanda, N., Bonin, C., Busacca, M., Candiani, M., et al. (2019) · Human Reproduction Open · doi:10.1093/hropen/hoz009 · Cited by 64 · see citing works
Self-citationMedical Treatment for Endometriosis: Tolerability, Quality of Life and Adherence
Barbàra, G., Buggio, L., Facchin, F., & Vercellini, P. (2021) · Frontiers in Global Women s Health · doi:10.3389/fgwh.2021.729601 · Cited by 60 · see citing works
Self-citationDonnez, J., & Dolmans, M. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms222111342 · Cited by 49 · see citing works
Guideline No. 449: Diagnosis and Impact of Endometriosis – A Canadian Guideline
Singh, S. S., Allaire, C., Al‐Nourhji, O., Bougie, O., Bridge-Cook, P., Duigenan, S., Kroft, J., Lemyre, M., Leonardi, M., Leyland, N. A., et al. (2024) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2024.102450 · Cited by 51 · see citing works
Elagolix for endometriosis: all that glitters is not gold
Vercellini, P., Viganò, P., Barbàra, G., Buggio, L., Somigliana, E., ‘Luigi Mangiagalli’ Endometriosis Study Group, Aimi, G., Alberico, D., Barbàra, G., Benaglia, L., et al. (2018) · Human Reproduction · doi:10.1093/humrep/dey368 · Cited by 45 · see citing works
Self-citationMijatovic, V., & Vercellini, P. (2024) · Human Reproduction · doi:10.1093/humrep/dead262 · Cited by 60 · see citing works
Self-citationFacchin, F., Buggio, L., & Saita, E. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.110213 · Cited by 33 · see citing works
Self-citationResveratrol impairs cellular mechanisms associated with the pathogenesis of endometriosis
Madanes, D., Meresman, G. F., Valla, S., Hassan, N., Kiesel, L., Greve, B., Barañao, R. I., Götte, M., & Ricci, A. G. (2022) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2022.02.008 · Cited by 26 · see citing works
Cormack, B. A. M., Maenhoudt, N., Fincke, V. E., Stejskalová, A., Greve, B., Kiesel, L., Meresman, G. F., Vankelecom, H. E. J., Götte, M., & Barañao, R. I. (2021) · Human Reproduction · doi:10.1093/humrep/deab053 · Cited by 25 · see citing works
Vercellini, P., Frattaruolo, M. P., & Buggio, L. (2018) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1080/14737167.2018.1411803 · Cited by 24 · see citing works
Self-citationVarious types of adenomyosis and endometriosis: in search of optimal management
Guo, S. (2023) · Fertility and Sterility · doi:10.1016/j.fertnstert.2023.03.021 · Cited by 24 · see citing works
Vercellini, P., Viganò, P., Frattaruolo, M. P., Borghi, A., & Somigliana, E. (2018) · Human Reproduction · doi:10.1093/humrep/dey104 · Cited by 20 · see citing works
Self-citationO’Brien, L., Morărașu, Ș., Morarasu, B. C., Neary, P. C., Muşină, A. M., Velenciuc, N., Roată, C. E., Dimofte, M. G., Luncă, S., Raimondo, D., et al. (2023) · International Journal of Colorectal Disease · doi:10.1007/s00384-023-04352-6 · Cited by 15 · see citing works
Evaluation and management of endometriosis
Yoldemir, T. (2023) · Climacteric · doi:10.1080/13697137.2023.2190882 · Cited by 13 · see citing works
Current and emerging therapies for endometriosis-associated pain: a review
Tijani, E. O., Ajayi, L. O., Tijani, O. S., Akano, O. P., & Ajayi, A. F. (2025) · Middle East Fertility Society Journal · doi:10.1186/s43043-025-00221-0 · Cited by 14 · see citing works
Scime, N. V., Brown, H. K., Metcalfe, A., & Brennand, E. A. (2021) · Women s Health Reports · doi:10.1089/whr.2021.0069 · Cited by 13 · see citing works
Vercellini, P., Bandini, V., Buggio, L., Barbàra, G., Berlanda, N., Dridi, D., Frattaruolo, M. P., & Somigliana, E. (2023) · Human Reproduction Open · doi:10.1093/hropen/hoad008 · Cited by 11 · see citing works
Self-citationUnmet treatment needs in patients with chronic pelvic pain in a New Zealand gynaecology service
Joseph, K. E., & Mills, J. (2019) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/ajo.13059 · Cited by 10 · see citing works
Use of Elagolix in Gynaecology
Taylor, H. S. (2018) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2018.01.004 · Cited by 9 · see citing works
Assessing healthcare needs in endometriosis: a scoping review
Timková, V., Mikula, P., Katreniaková, Z., Howick, J., & Nagyová, I. (2025) · Psychology and Health · doi:10.1080/08870446.2025.2478154 · Cited by 7 · see citing works
Vercellini, P., Ottolini, F. L., Frattaruolo, M. P., Buggio, L., Roberto, A., & Somigliana, E. (2018) · Gynecologic and Obstetric Investigation · doi:10.1159/000486335 · Cited by 8 · see citing works
Self-citationApproaching ovarian endometrioma with medical therapy
Vignali, M., SOLIMA, E., BARBERA, V., BECHERINI, C., & BELLONI, G. M. (2021) · Minerva Obstetrics and Gynecology · doi:10.23736/s2724-606x.20.04751-6 · Cited by 4 · see citing works
Effects of dienogest on bone mineral density during the year of endometriosis treatment
Balan, V. E., Orlova, S. A., Kuznetsov, S. U., Grigor'eva, D. V., & Lazareva, I. N. (2017) · Russian Journal of Human Reproduction · doi:10.17116/repro201723666-70 · Cited by 4 · see citing works
The Financial Toxicity of Endometriosis: Unseen Costs and Policy Gaps
Abousifein, M. E., & Leyland, N. A. (2025) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2025.103188 · Cited by 3 · see citing works
Medical Treatment for Endometriosis: One Size Does Not Fit All
Vercellini, P., Salmeri, N., Bandini, V., Conca, B., Viganò, P., Somigliana, E., & Vignali, M. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15062408 · Cited by 3 · see citing works
Self-citationEndometrioma: a new paradigm of diagnostics and therapeutic tactics
Gasparyan, S. A., Vasilenko, I. A., Popova, O., & Lifenko, R. A. (2019) · Russian Journal of Human Reproduction · doi:10.17116/repro20192506178 · Cited by 3 · see citing works
Ethical analysis of the change of values in healthcare
Hansen, D., Aleksandrova–Yankulovska, S., & Steger, F. (2025) · Nursing Ethics · doi:10.1177/09697330251319374 · Cited by 3 · see citing works
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Johnston, E. G. (2026) · International Journal of Transgender Health · doi:10.1080/26895269.2026.2637852 · Cited by 1 · see citing works
Hormonal Therapies before In-Vitro Fertilization in Women with Endometriosis
Naem, A., & Laganà, A. S. (2024) · Springer eBooks · doi:10.1007/978-3-031-50662-8_14
Directive clinique no 449 : Directive canadienne sur le diagnostic et les impacts de l’endométriose
Singh, S. S., Allaire, C., Al‐Nourhji, O., Bougie, O., Bridge-Cook, P., Duigenan, S., Kroft, J., Lemyre, M., Leonardi, M., Leyland, N. A., et al. (2024) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2024.102451
Aslan, K., Kasapoğlu, I., Kosan, B., & Uncu, G. (2026) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2026.08.001
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- Authors
- Vercellini, P., Facchin, F., Buggio, L., Barbara, G., Berlanda, N., Frattaruolo, M. P., & Somigliana, E.
- Affiliations
- University of Milan (IT)
- Università Cattolica del Sacro Cuore (IT)
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- Corresponding author
- Vercellini, Paolo
- ORCID
- Venue
- Journal of Obstetrics and Gynaecology Canada
- Publisher
- Elsevier BV
- Published
- 2018-06
- Volume
- 40
- Issue
- 6
- Pages
- 726-749.e10
- ISSN
- 1701-2163 (ISSN-L)
- OpenAlex
- W2761947111
- Cited by
- 36
- References
- 298
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 4 · 2023: 4 · 2022: 1 · 2021: 6 · 2020: 1 · 2019: 3 · 2018: 6 · 2017: 2
- FWCI
- 0.54
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Journal of Obstetrics and Gynaecology Canada (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- Funders
- Ferring
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
- EMD Serono (5x1000)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- endometriosis, low-value care, cost-effectiveness, value-based care, financial toxicity, overuse of diagnostic testing, patient preferences, patient-centered care, physician empathy, health care expenditure, cost-related nonadherence
- MeSH terms
- Adolescent, Cost-Benefit Analysis, Costs and Cost Analysis, Endometriosis, Female, Fertilization in Vitro, Health Priorities, Humans, Infertility, Female, Menopause, Ovarian Neoplasms, Ovariectomy, Conflict of Interest, Treatment Outcome, Hormone Replacement Therapy, Patient Preference, Pain Management
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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