Trends in Prevalence, Management and Cost of Scrotal Pain in the United States between 2007 and 2014

Introduction: We characterize trends in the prevalence, diagnosis and management of scrotal pain in men in the United States and the financial impact on the health care system. Methods: We analyzed subjects from the Truven Health MarketScan (R) claims database from 2007 to 2014. Clinical encounters and diagnoses of scrotal pain were identified using ICD-9 and CPT (R) codes. Trends in office visits, emergency department encounters, radiological evaluation, scrotal surgeries and pharmaceutical prescription were identified, as well as net financial cost. Results: A total of 1,083,350 men with scrotal pain were analyzed during 8 years, amounting to 4,356,581 patient-years of followup. Overall prevalence increased from 0.8% to 1% between 2007 and 2014. Increasing numbers of varicoceles, hydroceles, spermatoceles and testicular torsion were also noted in these men. The percentage of men with scrotal pain evaluated by ultrasonography increased from 39% to 45%, while the percentage of those with scrotal pain presenting to the emergency department increased from 8% to 10%. Scrotal surgery rates did not change substantially (decreasing from 1.7% to 1.6%). However, prescription of opiates and nonsteroidal anti-inflammatory drugs increased from 14% to 42% and from 13% to 46% for all clinic visits, respectively. Yearly cost attributable to scrotal pain was $55,923,986 and median annual cost per patient increased between 2007 and 2014. Conclusions: Incidence of scrotal pain and associated use of prescription medication have increased in the last decade, contributing to a high economic burden. A greater understanding of the evaluation and management of scrotal pain is necessary.