Discontinuation of testosterone replacement therapy in patients with late-onset hypogonadism: A 10-year observational study

Park, H.J.; Park, J.H.; Kim, K.H.; Kang, Byeong‐Teck; Baek, Seung Ryong; Park, N.C.

doi:10.1016/s2666-1683(20)32630-6

Cited by 1 publication

(2 citation statements)

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“…A small proportion of hypogonadal men might discontinue testosterone during the first year of treatment with most of them resuming treatment after a short period of time. 41 While the assumption of no discontinuation constitutes a limitation of our model, allowing for the cost of testosterone and limited QoL benefits seems to be supported by the long-term QoL IPD analysis results where no differences in utilities were observed. A limitation of the mapping approach provided by Grochtdreis et al is that it was mapped within the psychotherapeutic outpatient setting, which may not be generalisable to our population.…”

Section: Discussionmentioning

confidence: 77%

“…The implication of this structural assumption is that all the individuals under the testosterone strategy will accrue the cost and benefits of testosterone in the long term. A small proportion of hypogonadal men might discontinue testosterone during the first year of treatment with most of them resuming treatment after a short period of time 41 . While the assumption of no discontinuation constitutes a limitation of our model, allowing for the cost of testosterone and limited QoL benefits seems to be supported by the long‐term QoL IPD analysis results where no differences in utilities were observed.…”

Section: Discussionmentioning

confidence: 90%

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Cost‐effectiveness of testosterone treatment utilising individual patient data from randomised controlled trials in men with low testosterone levels

Hernández,

de Silva,

Hudson

et al. 2024

Andrology

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BackgroundTestosterone is safe and highly effective in men with organic hypogonadism, but worldwide testosterone prescribing has recently shifted towards middle‐aged and older men, mostly with low testosterone related to age, diabetes and obesity, for whom there is less established evidence of clinical safety and benefit. The value of testosterone treatment in middle‐aged and older men with low testosterone is yet to be determined. We therefore evaluated the cost‐effectiveness of testosterone treatment in such men with low testosterone compared with no treatment.MethodsA cost‐utility analysis comparing testosterone with no treatment was conducted following best practices in decision modelling. A cohort Markov model incorporating relevant care pathways for individuals with hypogonadism was developed for a 10‐year‐time horizon. Clinical outcomes were obtained from an individual patient meta‐analysis of placebo‐controlled, double‐blind randomised studies. Three starting age categories were defined: 40, 60 and 75 years. Cost utility (quality‐adjusted life years) accrued and costs of testosterone treatment, monitoring and cardiovascular complications were compared to estimate incremental cost‐effectiveness ratios and cost‐effectiveness acceptability curves for selected scenarios.ResultsTen‐year excess treatment costs for testosterone compared with non‐treatment ranged between £2306 and £3269 per patient. Quality‐adjusted life years results depended on the instruments used to measure health utilities. Using Beck depression index‐derived quality‐adjusted life years data, testosterone was cost‐effective (incremental cost‐effectiveness ratio <£20,000) for men aged <75 years, regardless of morbidity and mortality sensitivity analyses. Testosterone was not cost‐effective in men aged >75 years in models assuming increased morbidity and/or mortality.Conclusions and future researchOur data suggest that testosterone is cost‐effective in men <75 years when Beck depression index‐derived quality‐adjusted life years data are considered; cost‐effectiveness in men >75 years is dependent on cardiovascular safety. However, more robust and longer‐term cost‐utility data are needed to verify our conclusion.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 90%