Anna Klepchukova, MD, Erica Stockwell, DO, discuss digital symptom checkers for endometriosis

A recent economic evaluation study published in npj Digital Medicine suggested that digital symptom checkers (SCs)¹ could significantly mitigate the diagnostic and financial burdens associated with endometriosis. The peer-reviewed study used a Markov decision process model to compare a digital SC with the standard of care from a societal perspective over a 40-year horizon. Researchers found that the integration of these digital tools could reduce diagnostic delay by 4.36 years and generate substantial cost savings for the health care system.^1,2

According to a news release from Flo Health, whose scientists collaborated on the research, enabling a diagnosis up to 4 years earlier could significantly improve disease burden over time.

The Markov decision process model demonstrated that the digital SC produced an incremental net monetary benefit (INMB) of $10,089.00 at a $100,000/QALY threshold. Probabilistic sensitivity analysis confirmed these findings were robust, showing an INMB of $12,398.92 (95% CI: $11,893.11–$12,904.72). From a clinical perspective, the tool generated 0.049 quality-adjusted life years (QALYs) per person.

Although these clinical improvements were described as a modest addition of nearly 3 weeks of healthy life per patient, the economic impact was more pronounced. The study reported $5,196.22 in savings per person over the 40-year timespan, resulting from a combination of reduced medical costs and diminished productivity loss. The researchers noted that the greatest value is realized when the symptom checker maintains a sensitivity and specificity of at least 0.7, user compliance exceeds 45%, and the time horizon is at least 10 years.

Flo Health’s chief medical officer, Anna Klepchukova, MD, and Erica Stockwell, DO, MBA, FACOG, who validated the study data, share their key takeaways from the study in the Q&A interview below with Contemporary OB/GYN.

Contemporary OB/GYN:

What question were you hoping to answer by evaluating a digital symptom checker for endometriosis?

Anna Klepchukova, MD:

Our study set out to assess how digital symptom checker tools can provide value for patients and health care systems. We did this by assessing if a digital symptom checker could reduce the diagnostic delay typically seen with endometriosis diagnoses and save costs associated with the condition by providing education and empowering women to seek medical attention for their symptoms earlier.

A Markov model is an established methodology in health economic evaluations that simulates patients’ care pathways using clinical and economic data and extrapolates these over time, in our case, a 40-year horizon.

Contemporary OB/GYN:

The model showed both quality-of-life gains and cost savings. What were the key drivers behind those benefits?

Klepchukova:

Both are chiefly due to reduced diagnostic delays. On average, it takes 7 years to get a diagnosis for endometriosis; that’s a long time during which women visit, on average, 7 different doctors, undergoing potentially unnecessary and inconclusive tests and consultations. More timely and less costly treatment leads to savings in medical costs as well as a reduction in productivity losses. Better health outcomes due to timely care are linked with quality of life gains.

Contemporary OB/GYN:

Your analysis found the tool remained cost-effective across multiple scenarios. What factors were most important in determining its value?

Klepchukova:

The key drivers of cost-effectiveness were accuracy of the digital symptom checker, compliance, and uptake. High accuracy (both sensitivity and specificity at ≥0.7) and compliance at levels exceeding 45% were central to providing value. Uptake was somewhat less important than compliance; however, uptake is key to scaling successfully into real-world settings.

Contemporary OB/GYN:

The study suggests the symptom checker could reduce diagnostic delay by more than 4 years. How significant is that for patients with endometriosis?

Erica Stockwell, DO, MBA, FACOG:

A reduction of more than 4 years and diagnostic delay for endometriosis would be extremely significant clinically, economically, and psychologically. Endometriosis is one of the conditions with the longest diagnostic delays in medicine, and shortening that delay directly affects disease severity, fertility, and quality of life. Most studies show an average delay of 6 to 10 years from symptom onset to diagnosis, which means that a symptom checker that reduces delay by 4 years could potentially cut the diagnostic timeline by roughly 40% to 60%.

Bottom line, this could be transformative for endometriosis care. It could substantially decrease disease severity, improve fertility outcomes, reduce chronic pain syndromes, and lower health care costs.

Contemporary OB/GYN:

Based on these findings, how might digital symptom checkers realistically fit into the pathway for identifying endometriosis earlier?

Stockwell:

Digital symptom checkers can accelerate endometriosis identification if they are embedded at specific points in the care pathway. Their greatest value is pattern recognition and triage, not diagnosis. When integrated properly, they can move patients toward earlier evaluation by clinicians familiar with endometriosis. Bottom line, digital symptom checkers fit best as early recognition and triage tools in the care pathway. Their main value is identifying symptom patterns that suggest endometriosis and directing patients toward appropriate evaluation earlier, potentially reducing diagnostic delay by several years.

References:

1. Fitch J. Digital symptom checkers could reduce diagnostic delay of endometriosis by 4 years. Contemporary OB/GYN. Published March 2, 2026. Accessed March 29, 2026. https://www.contemporaryobgyn.net/view/digital-symptom-checkers-could-reduce-diagnostic-delay-of-endometriosis-by-4-years
2. New Flo Health Study Suggests Women Could Get Endometriosis Diagnoses More Than 50% Sooner. Flo Health. Press release. Published March 2, 2026. Accessed March 2, 2026. https://flo.health/newsroom/new-flo-health-study-suggests-women-could-get-endometriosis-diagnoses-more-than-50-sooner