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The Direct and Indirect Costs among U.S. Privately Insured Employees with Hypogonadism


Anna Kaltenboeck, MA, Analysis Group, Inc., 10 Rockefeller Plaza, 15th Floor, New York, NY 10020, USA. Tel: (212) 492-8100; Fax: (212) 492-8188; E-mail:


Introduction.  While previous studies have noted that hypogonadism (HG) may pose a significant economic and quality-of-life burden, no studies have evaluated the impact of HG on healthcare utilization and costs in the United States.

Aim.  Compare direct (health care) and indirect (disability leave or medical absence) costs between privately insured U.S. employees with HG and controls without HG.

Methods.  The study sample included 4,269 male employees, ages 35–64, with ≥2 HG diagnoses (International Classification of Diseases, Ninth Revision, Clinical Modification: 257.2x) or ≥1 HG diagnosis and ≥1 claim for testosterone therapy, 1/1/2005–3/31/2009, identified from a large, private insurance administrative database that includes medical, prescription drug, and disability claims data. The index date was the most recent HG diagnosis that had continuous eligibility for at least 1 year before (baseline period) and 1 year after (study period). Employees with HG were matched 1:1 on age, region, salaried vs. nonsalaried employment status, and index year to controls without HG.

Main Outcome Measures.  Descriptive analyses compared demographic characteristics, comorbidities, resource utilization, direct and indirect costs inflated to USD 2009. Multivariate analyses adjusting for baseline characteristics were used to estimate risk-adjusted costs.

Results.  HG employees and controls had a mean age of 51 years. HG employees compared with controls had higher baseline comorbidity rates, including hyperlipidemia (50.2% vs. 25.3%), hypertension (37.7% vs. 21.1%), back/neck pain (32.0% vs. 15.7%), and human immunodeficiency virus/acquired immunodeficiency syndrome (7.1% vs. 0.3%) (all P < 0.0001). HG employees had higher mean study period direct ($10,914 vs. $3,823) and indirect costs ($3,204 vs. $1,450); HG-related direct costs were $832 (all P < 0.0001). Risk-adjusted direct ($9,291 vs. $5,248) and indirect ($2,729 vs. $1,840) costs were also higher for HG employees (all P < 0.0001).

Conclusions.  Employees with HG had higher comorbidity rates and costs compared with controls. Given the low HG-related costs, a primary driver of costs among HG patients appears to be their comorbidity burden. Kaltenboeck A, Foster S, Ivanova J, Diener M, Bergman R, Birnbaum H, Kinchen K, and Swindle R. The direct and indirect costs among U.S. privately insured employees with hypogonadism. J Sex Med 2012;9:2438–2447.