New research: Can digital tools, like symptom checkers, cut endometriosis diagnosis time?

Endometriosis is a chronic condition that affects around 190 million women globally (roughly 10% of women of reproductive age). 

It is marked by inflammation, pelvic pain and, sometimes, infertility. Despite how common and debilitating the condition is, on average, women visit seven different doctors and wait seven years or longer to receive a diagnosis. 

Those years of delay often mean reduced quality of life, lost wages, and high medical costs. In the United States alone, the economic burden of endometriosis is estimated to be between $78 and $119 billion annually.

A new study led by Flo’s science team found that using digital tools, like symptom checkers for endometriosis could dramatically shorten the time to diagnosis and significantly reduce societal costs by educating and encouraging earlier care-seeking.

The project was a collaboration with researchers at London School of Hygiene and Tropical Medicine and York Health Economics Consortium, both in the United Kingdom.

The research is published in the journal npj Digital Medicine, part of the prestigious Nature Portfolio publishing group.  

Benefits for patients and society

In this study, our scientists and their collaborators used health economic modelling to explore how a digital symptom checker, if used as intended and when used alongside standard care, could influence outcomes over a 40 year time span. 

Our scientists developed a model to simulate the journey of 20-year-old women in the United States with symptoms suggestive of endometriosis.

They compared two scenarios. The first represents the “standard of care,” based on the typical journey of patients seeking diagnosis, care, and treatment for endometriosis. The second represents a “digital intervention” path, where women use Flo’s Symptom Checker to receive information on her symptoms and receive guidance about visiting their doctor if their symptoms match with those common in endometriosis.

Although symptom checkers are non-diagnostic, informational tools and not regulated medical devices, they serve as critical catalysts in the diagnostic process. By improving patient health literacy, they significantly reduce the time-to-consultation without overstepping the boundaries of professional clinical practice.

The model showed that digital symptom checkers could reduce the diagnostic delay by an average of 4.36 years due to earlier notification and explanation of symptoms and more effective and timely subsequent care seeking. 

This translates to approximately 18 additional days of healthy life. 

“This health economic evaluation of Flo’s digital Symptom Checker contributes to a growing body of evidence for a historically under-researched condition," commented coauthor Laura Kelly, MPH, a senior health economist from the York Health Economics Consortium in the United Kingdom. “The findings highlight the potential for digital tools to shorten the time to diagnosis of endometriosis, leading to benefits for both patients and the wider health care system.”

Beyond the physical and emotional relief of an earlier diagnosis, the study highlighted significant economic benefits. The researchers performed a cost estimation from the societal perspective, which looked at both direct medical costs and indirect costs like lost productivity.

The model estimated that Flo’s digital Symptom Checker could save an average of $5,196 per person over a 40-year period compared with standard care. These savings come from lower direct medical costs and better productivity due to more timely diagnosis and care for symptoms. 

When the researchers looked at the broader impact on society, the results were even more compelling. They calculated the “net monetary benefit,” which is a standard economic measure that combines financial savings with the monetary value of improved health. 

Here, the total societal benefit was $10,089 per person.* 

A new standard for female health

Flo’s study is the first economic evaluation of digital symptom checkers for endometriosis and demonstrates how technology can solve systemic health care challenges. 

“An important caveat is that there are certain conditions that a symptom checker must meet to deliver the type of value our model demonstrated,“ Yihan Xu, PhD, lead research scientist and health economist at Flo and lead study author, explained. 

“The accuracy of the symptom checker should be above 70%, user compliance needs to be relatively high, at least 45%, and the outcomes need to be evaluated over a time horizon of at least 10 years. This might sound technical, but these boundary conditions are important to highlight. Our model demonstrated that efficient symptom checkers, that meet these conditions, have the potential to deliver better health outcomes for patients while simultaneously reducing the strain on the health care system,“ she continued. 

The team further calls for more research in the future, particularly longitudinal studies with real-word data to assess whether digital symptom checkers meaningfully change diagnostic timelines and outcomes in practice.

The study ultimately suggests that digital tools can serve as a bridge between patients and health care systems. By validating patients’ symptoms early and providing data-backed reports, apps like Flo can help dismantle the barriers that prevent timely care. 

As the research shows, this can benefit both patients and the wider society. 

“Endometriosis has long been a blind spot in women’s health, with diagnostic delays that are simply unacceptable,” said Liudmila Zhaunova, PhD, senior study author and director of science at Flo. “Our research validates that digital technologies can be powerful public health interventions. By putting digital tools directly into women’s hands, we can fundamentally change the trajectory of this disease.”

Footnote:

* The incremental net monetary benefit was estimated assuming a willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY), a common benchmark for US institutional payers.