Could a Saliva Test Change the Business Cost of Endometriosis?
For years, one of the biggest challenges surrounding endometriosis hasn’t only been treating the condition. It’s been identifying it in the first place.
Women can spend years moving between appointments, scans and specialists before receiving a clear diagnosis. A large 2026 French study of nearly 7,000 participants reported an average diagnostic delay of 10 years. During that time, the impact doesn’t stay within the healthcare system. It follows women into their daily lives and workplaces through pain, absence, reduced productivity and, in some cases, decisions to step back from work altogether.
Now, a new diagnostic approach could start to change that equation: testing for endometriosis through saliva.
The technology is still being evaluated for how it should be used at scale, but recent clinical results and developments in France and the UK suggest saliva testing is moving from an experimental innovation towards real-world healthcare use. For businesses, insurers and healthcare systems, that’s worth paying attention to.
Endometriosis: a health issue with a business cost
Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows elsewhere in the body. It can cause severe period and pelvic pain, fatigue, pain during sex, digestive problems and fertility difficulties.
The symptoms vary significantly between women and can overlap with other conditions. That makes diagnosis difficult. Ultrasound and MRI can identify some forms of endometriosis, but they don’t always provide a clear answer. In more complex cases, women may move through repeated consultations and investigations before receiving a diagnosis.
A 2025 Global Burden of Disease analysis identified 22.28 million prevalent cases worldwide in 2021 among women of childbearing age. At the same time, recent research continues to show substantial diagnostic delays, suggesting the challenge isn’t simply how many women have endometriosis, but how long many live with symptoms before getting answers.
And those years come at a cost.
A 2024 population study in Northern Cyprus estimated the average annual economic burden of endometriosis at approximately Int$9,864 per affected woman, including healthcare spending, absence and lost productivity. Importantly, productivity loss at work was the largest component of the overall cost.
Recent Danish data tell a similar story. A 2025 study following more than 2.6 million women found that those diagnosed with endometriosis lost more working time over their careers and were more likely to leave employment through disability pension. In a supplementary workforce survey, 16.2% of women with endometriosis reported 4-28 sick days in the previous four weeks, compared with 7.9% of women without it. They were also roughly twice as likely to report that physical pain substantially interfered with their work: 17.5% versus 8.4%.
So when we talk about improving endometriosis diagnosis, we’re not only talking about better healthcare. We’re talking about reducing years of uncertainty that can translate into healthcare costs, sick leave, presenteeism, and long-term workforce participation.
How can saliva help?
The science is sophisticated, but the idea is relatively simple.
The best-known saliva test currently being evaluated in Europe, Ziwig Endotest, analyses 109 biological markers called microRNAs.
MicroRNAs are tiny molecules that help regulate how genes behave. Certain diseases can create recognisable patterns in these molecules. The test takes a saliva sample, analyses its microRNA profile and uses an algorithm to determine whether the pattern is consistent with endometriosis.
In other words, instead of trying to physically see endometriosis through a scan or surgery, the test looks for a biological fingerprint associated with the disease.
For the patient, collecting the sample is simple. The complex analysis happens in a specialized laboratory.
What does the latest evidence show?
The technology has progressed considerably since the first prospective study of 200 women was published in 2022.
The most important milestone came in 2025, when researchers published results from a prospective multicentre validation study involving 971 patients across 17 centres.
The saliva test achieved:
96.6% overall accuracy
97.3% sensitivity – its ability to correctly identify people with endometriosis
94.1% specificity – its ability to correctly identify those without it
Among patients whose diagnosis was confirmed surgically, the saliva test had a 4.6% misclassification rate, compared with 27.2% for ultrasound and/or MRI in the study.
These are impressive results, but they need context. Around 77% of participants in the validation study had endometriosis, meaning it was tested in a population where there was already a high suspicion of the disease. It shouldn’t therefore be interpreted as evidence for using the test as a universal screening tool for every woman.
Its immediate value may instead be at a particularly expensive and frustrating point in the healthcare journey: when a woman has persistent symptoms, but imaging hasn’t provided a clear answer.
And this is where the business case becomes particularly interesting.
Could earlier diagnosis actually reduce costs?
A 2023 French cost-effectiveness analysis modelled different ways of introducing Endotest into the diagnostic pathway.
Using a test price of €750, the estimated cost per correctly diagnosed patient was:
· €1,542 using the conventional French diagnostic pathway
· €990 when all eligible patients received Endotest
· €919 when ultrasound was followed by Endotest where appropriate
· €1,000 when Endotest was used after ultrasound and MRI
In the model, the conventional diagnostic strategy was economically outperformed by the alternatives incorporating the saliva test. These are modelled rather than real-world savings, so they shouldn’t be treated as proof that every healthcare system will achieve the same outcome. But they demonstrate where the commercial argument lies: the value of the test may not be its price alone, but what it could remove from the diagnostic journey.
Fewer inconclusive investigations. Fewer repeated specialist appointments. Potentially fewer unnecessary invasive procedures. And, crucially, less time before a patient reaches an appropriate diagnosis and care pathway.
Healthcare systems are beginning to test that proposition in practice.
In France, national health insurance introduced a three-year reimbursement programme for ENDOTEST. The reimbursement package is set at €839 per patient, covering the diagnostic device and associated clinical activity, and the programme allows up to 25,000 patients to receive the test.
In July 2026, NICE also issued draft guidance recommending Endotest and another non-invasive technology for limited use in the NHS while additional evidence is gathered over three years. NICE specifically highlighted their potential to support earlier diagnosis, while acknowledging that evidence on clinical and cost-effectiveness is still developing.
That distinction matters. Saliva testing hasn’t yet become the universal new standard for diagnosing endometriosis. But it’s reached a point where major European health systems are willing to invest in its use while collecting real-world evidence.
Why should employers care?
Employers aren’t responsible for diagnosing endometriosis. But they do experience the economic consequences of delayed diagnosis.
Someone who doesn’t know why she’s experiencing severe pain or fatigue may still come to work, but not be able to perform at her usual capacity. She may need repeated medical appointments. She may take recurring sick leave. Over time, unsupported symptoms can affect career progression, confidence and decisions about whether to remain in the workforce.
The potential business impact of faster diagnosis therefore extends beyond reducing absence.
Earlier answers can mean earlier access to appropriate treatment and workplace support. That could help women manage symptoms before they escalate into longer periods of absence or disengagement.
For employers, the development also reinforces a broader shift in women’s health. The conversation is moving beyond simply offering support once someone has a confirmed condition. Increasingly, there’s an opportunity to help employees recognize symptoms, navigate healthcare and reach the right support sooner.
That could mean better education about endometriosis, benefits that cover specialist care, clearer pathways through health insurers, manager awareness and flexibility during the diagnostic process.
The real opportunity is reducing the years in between
A saliva test won’t remove endometriosis. And it won’t solve every challenge surrounding women’s health at work.
Its real potential is simpler: it could help remove some of the uncertainty between “something is wrong” and “we know what it is.”
When that gap can last seven, nine or even ten years, shortening it has value far beyond the laboratory.
For healthcare systems, it could mean a more efficient diagnostic pathway.
For insurers, it could mean reconsidering where spending earlier in the patient journey prevents higher costs later.
For employers, it could mean fewer years in which talented women are trying to manage unexplained symptoms alongside their careers.
And for women, most importantly, it could mean being believed and supported sooner.
The next stage will be proving that the strong diagnostic results seen in clinical studies translate into faster diagnosis, better treatment decisions and measurable economic savings in the real world.
But the direction is promising. Saliva testing is turning endometriosis diagnosis from a purely clinical challenge into something businesses, healthcare systems and policymakers should be watching closely.
Written by Hasti Khatami