A cost effectiveness analysis of goserelin compared with danazol as endometrial thinning agents

Abstract

Objective To analyse the cost, effectiveness and cost effectiveness of two endometrial thinning agents Setting A district general hospital.Design A retrospective cost effectiveness analysis, from the perspective of the health service, based ondata from an open, randomised, parallel group comparative study of 160 pre-menopausal women with dysfunctional uterine bleeding.Methods Within the trial, length of operation and duration of hospital stay was recorded for each woman. Resource use due to complications of surgery and adverse drug events was evaluated by one of the authors (R.G.). Additional surgery after completion of the study was collected using a postal questionnaire which was distributed to every woman who had undergone surgery. Resource use was costed using detailed unit costs from a specific NHS trust and from published sources. A cost effectiveness analysis was undertaken relating differential cost to differential rates of amenorrhoea at women's last point of follow up.Results Information on amenorrhoea was available from 138 women, of whom 11 1 had completed the questionnaire to indicate longer term follow up. Women who did not complete the clinical trial were not included in this economic evaluation. On average, women randomised to goserelin spent less time in theatre and on the ward. Based on longer term follow up, rates of retreatment were similar in the two groups. The mean (SD) health service cost of women in the goserelin group was E323.84 (E309.94). compared with E243. 45 (2265.23) in the danazol group; median (range) costs were &220-29 (f19142127) and f159-76 (f14041426) in the two groups, respectively. These costs were significantly higher for goserelin (P = 0.0001). The goserelin group also had a higher rate of amenorrhoea (38.8% vs 28.6%, P = 0.23). Based on mean differences in cost, the incremental cost of goserelin per additional woman with amenorrhoea was E788; based on median differences in cost the ratio was f590.The shorter duration in theatre and stay in hospital provided a modest offset of the higher acquisition cost of goserelin, but the overall cost of management remained significantly higher than managing women with danazol. The rates of amenorrhoea indicated that goserelin was more effective at 24 weeks and approximately two years after surgery, although statistical significance was only achieved at 24 weeks. The economic impact of women withdrawn from treatment was not considered, but sensitivity analysis indicates that these women may have had a large effect on the overall result of this study. Purchasers will need to decide whether the additional cost of management with goserelin is justified by the increased rates of amenorrhoea and the reduced withdrawals from treatment.prior to laser ablation for dysfunctional uterine bleeding: danazol and goserelin. Conclusions INTRODUCTIONally with drugs, and 822,000 prescriptions costing f 7 million are written annually -in the-UK4. However, women have frequently been prescribed the least effectherapy.Traditionally, abdominal hysterecto...

Menorrhagia: an update

“…A cost‐effectiveness analysis of preoperative endometrial suppression with danazol vs. GnRH agonists suggested the health care costs to be greater with GnRH agonists. However, the study also concluded that amenorrhea rates were slightly higher in the GnRH‐treated group, and the study withdrawals were greater in the danazol‐treated group (147).…”

Clinical use of GnRH analogues

“…Dysfunctional uterine bleeding (DUB), defined as excessive menstruation not due to recognizable pelvic or medical disease, has been traditionally treated with progestogens, oral contraceptive pills, danazol, and nonsteroidal anti‐inflammatory or antifibrinolytic agents. If hormonal therapy failed, hysterectomy was performed in 35–64% of the 70 000 hysterectomies in the UK (Sculpher et al ., 2000). But now a range of ‘minimal access’ procedures, such as endometrial ablation with destruction of the basal layer of the endometrium, may be performed.…”

A multicentre randomised controlled trial assessing the costs and benefits of using structured information and analysis of women's preferences in the management of menorrhagia

“…The items costed and source of unit costs (prices) are summarised in Table 1. [37][38][39][40][41] The calculation of the intervention costs is shown in Table 2. 3,42,43 Fixed costs, incurred through the expert input required for the content of the information pack and interview and the production of the booklet and video, are averaged over the total potential eligible population.…”