Pharmaceutical treatments to prevent recurrence of endometriosis following surgery: a model-based economic evaluation

Abstract

ObjectiveConduct an economic evaluation based on best currently available evidence comparing alternative treatments levonorgestrel-releasing intrauterine system, depot-medroxyprogesterone acetate, combined oral contraceptive pill (COCP) and ‘no treatment’ to prevent recurrence of endometriosis after conservative surgery in primary care, and to inform the design of a planned trial-based economic evaluation.MethodsWe developed a state transition (Markov) model with a 36-month follow-up. The model structure was informed by a pragmatic review and clinical experts. The economic evaluation adopted a UK National Health Service perspective and was based on an outcome of incremental cost per quality-adjusted life year (QALY). As available data were limited, intentionally wide distributions were assigned around model inputs, and the average costs and outcome of the probabilistic sensitivity analyses were reported.ResultsOn average, all strategies were more expensive and generated fewer QALYs compared to no treatment. However, uncertainty attributing to the transition probabilities affected the results. Inputs relating to effectiveness, changes in treatment and the time at which the change is made were the main causes of uncertainty, illustrating areas where robust and specific data collection is required.ConclusionsThere is currently no evidence to support any treatment being recommended to prevent the recurrence of endometriosis following conservative surgery. The study highlights the importance of developing decision models at the outset of a trial to identify data requirements to conduct a robust post-trial analysis.

Medical therapy for preventing recurrent endometriosis after conservative surgery: a cost‐effectiveness analysis

“…Our findings indicate that this recommendation may be reasonable because the economic outcomes associated with long‐term GnRH‐a use are more favorable than those associated with its short‐term use. Our findings were partly in accordance with those from a report recently published by Sanghera et al From a UK National Health Service perspective, the authors evaluated the cost‐effectiveness of a levonorgestrel‐releasing intrauterine system, depot‐medroxyprogesterone acetate, and the combined oral contraceptive pill in preventing the recurrence of endometriosis after conservative surgery in primary care over a 3‐year period. They found that none of the strategies was significantly beneficial compared with no treatment because of the high cost and fewer QALYs.…”

“…Currently, new regimens, such as aromatase inhibitors plus GnRH‐a, are under investigation in clinical trials . Other independent and influential parameters include the utility scores associated with endometriosis, which suggest that capturing accurate quality of life data is essential . The model output was not sensitive to the parameter associated with ovarian cancer, although an association of a history of endometriosis with an increased risk of ovarian cancer was apparent .…”

“…The only published economic analysis, done in the UK, compares different treatments for preventing the recurrence of endometriosis, including the levonorgestrel‐releasing intrauterine system, depot medroxyprogesterone acetate, combined oral contraceptive pill, and no medical therapy . However, we know of no studies investigating the cost‐effectiveness of GnRH‐a therapy.…”

“…11 The only published economic analysis, done in the UK, compares different treatments for preventing the recurrence of endometriosis, including the levonorgestrel-releasing intrauterine system, depot medroxyprogesterone acetate, combined oral contraceptive pill, and no medical therapy. 12 However, we know of no studies investigating the costeffectiveness of GnRH-a therapy. Although GnRH-a is often administered as a second-line option, in recent years it has received much attention and is prescribed frequently as a first-line option after the surgery because of its improved effectiveness in reducing recurrent episodes.…”

Radiomics

“…Outcome studies should include health economic considera�ons. Moreover, cost-per-quality-adjusted-life-year comparisons should be conducted with and without radiomics to more accurately determine the economic poten�al [101].…”