The Cost of Endometriosis and Chronic Pelvic Pain Burden in New Zealand (Aotearoa): Results from a Nationwide Survey

Endometriosis and chronic pelvic pain (CPP) impose substantial economic burden in New Zealand, yet no national cost-of-illness (COI) model currently exists. This study provides the first nationwide estimate using a modified World-Endometriosis-Research-Foundation (WERF) EndoCost protocol incorporating direct healthcare, productivity, and carer costs. An attribution correction model was applied to account for diagnostic overlap, assigning 43.4% of CPP cases to endometriosis. Attribution-adjusted annual per capita costs were INT 97,497 (NZD 174,130) for endometriosis and INT 33,262 (NZD 59,406) for CPP. Macroeconomic costs ranged from INT 12.7B to 17.7B (NZD 22.6B–31.7B) per annum, depending on prevalence. Productivity losses were the primary cost driver, accounting for 65% of endometriosis and 75% of CPP cost. The unattributed lifetime burden was INT 1.96M (NZD 3.50M) per person for endometriosis and INT 1.54M (NZD 2.74M) per person with CPP. This reflects total economic burden over a 34.5-year working lifespan, adjusted for labor-force participation. Diagnostic delays and health system inefficiencies such as poor healthcare access and suboptimal symptom management are likely to be the most significant modifiable contributor to this burden. Addressing this will require investment in healthcare provision and symptom management alongside equitable access to fertility care.