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Medical therapy for preventing recurrent endometriosis after conservative surgery: a cost‐effectiveness analysis
Objective To assess the cost‐effectiveness of different strategies, including gonadotropin‐releasing hormone agonist (GnRH‐a) and oral contraceptive therapy, for the prevention of endometriosis recurrence after conservative surgery. Design Cost‐effectiveness analysis from a health care perspective....
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| Published in: | BJOG : an international journal of obstetrics and gynaecology 2018-03, Vol.125 (4), p.469-477 |
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| Language: | English |
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| container_end_page | 477 |
| container_issue | 4 |
| container_start_page | 469 |
| container_title | BJOG : an international journal of obstetrics and gynaecology |
| container_volume | 125 |
| creator | Wu, B Yang, Z Tobe, RG Wang, Y |
| description | Objective
To assess the cost‐effectiveness of different strategies, including gonadotropin‐releasing hormone agonist (GnRH‐a) and oral contraceptive therapy, for the prevention of endometriosis recurrence after conservative surgery.
Design
Cost‐effectiveness analysis from a health care perspective.
Setting
A health‐resource‐limited setting in China.
Population
Patients who underwent conservative laparoscopic or laparotomic surgery for endometriosis.
Methods
A Markov model was developed for the endometriosis disease course. Clinical data were obtained from published studies. Direct medical costs and resource utilization in the Chinese health care setting were taken into account. The health and economic outcomes were evaluated over a period from treatment initiation to menopause onset. Sensitivity analyses were carried out to test the impact of various parameters and assumptions on the model output.
Main outcome measures
Quality‐adjusted life years (QALYs) gained and costs from a health care perspective.
Results
The incremental cost‐effectiveness ratio of 6‐month GnRH‐a therapy compared with no therapy ranged from $6,185 per QALY in deep endometriosis to $6,425 with peritoneal endometriosis. A one‐way sensitivity analysis showed considerable influential factors, such as remission rates and utility values. Probabilistic sensitivity analysis indicated that 6‐month GnRH‐a therapy is cost‐effective in most cases at a threshold of $7,400/QALY, regardless of the type of endometriosis.
Conclusion
Six months of therapy with GnRH‐a can be a highly cost‐effective option for the prevention of endometriosis recurrence.
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Gonadotropin‐releasing hormone agonist is cost effective for the prevention of endometriosis recurrence.
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| doi_str_mv | 10.1111/1471-0528.14786 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1909742767</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1909742767</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4126-3c53d40bd9bd4be4afc329aa5883e7d6c9ed984d6fec8465cf533dabe7c4e3aa3</originalsourceid><addsrcrecordid>eNqFkctO3DAUhi1UVG5ds6ssddNNGN_iJN0VxFWD2MDacuwTmlEmmR4nU2XHI_CMPAkOA7PoBm98fPz9v63_EHLM2QmPa8ZVxhOWivwkVrneIfvbzpe3miVMinyPHISwYIxrweRXsidyzaWSYp_gLfja2Yb2fwDtaqRVh3SFsIa2r9tHiuAGxHig0PpuCT3WXagDtVUPSF3XBsC17es10DDgI-D4i9rYD_3L0zNUFbjproUQJa1txqg9IruVbQJ8e98PycPF-f3ZVTK_u7w--z1PnOJCJ9Kl0itW-qL0qgRlKydFYW2a5xIyr10BvsiV1_GNXOnUVamU3paQOQXSWnlIfm58V9j9HSD0ZlkHB01jW-iGYHjBikyJTGcR_fEfuugGjP8NRjAmmOaKT9RsQznsQkCozArrpcXRcGamcZgpfDOFb97GERXf332Hcgl-y3_kH4F0A_yrGxg_8zOnN3cb41drUpiO</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2002061417</pqid></control><display><type>article</type><title>Medical therapy for preventing recurrent endometriosis after conservative surgery: a cost‐effectiveness analysis</title><source>Wiley</source><creator>Wu, B ; Yang, Z ; Tobe, RG ; Wang, Y</creator><creatorcontrib>Wu, B ; Yang, Z ; Tobe, RG ; Wang, Y</creatorcontrib><description>Objective
To assess the cost‐effectiveness of different strategies, including gonadotropin‐releasing hormone agonist (GnRH‐a) and oral contraceptive therapy, for the prevention of endometriosis recurrence after conservative surgery.
Design
Cost‐effectiveness analysis from a health care perspective.
Setting
A health‐resource‐limited setting in China.
Population
Patients who underwent conservative laparoscopic or laparotomic surgery for endometriosis.
Methods
A Markov model was developed for the endometriosis disease course. Clinical data were obtained from published studies. Direct medical costs and resource utilization in the Chinese health care setting were taken into account. The health and economic outcomes were evaluated over a period from treatment initiation to menopause onset. Sensitivity analyses were carried out to test the impact of various parameters and assumptions on the model output.
Main outcome measures
Quality‐adjusted life years (QALYs) gained and costs from a health care perspective.
Results
The incremental cost‐effectiveness ratio of 6‐month GnRH‐a therapy compared with no therapy ranged from $6,185 per QALY in deep endometriosis to $6,425 with peritoneal endometriosis. A one‐way sensitivity analysis showed considerable influential factors, such as remission rates and utility values. Probabilistic sensitivity analysis indicated that 6‐month GnRH‐a therapy is cost‐effective in most cases at a threshold of $7,400/QALY, regardless of the type of endometriosis.
Conclusion
Six months of therapy with GnRH‐a can be a highly cost‐effective option for the prevention of endometriosis recurrence.
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Gonadotropin‐releasing hormone agonist is cost effective for the prevention of endometriosis recurrence.
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Gonadotropin‐releasing hormone agonist is cost effective for the prevention of endometriosis recurrence.</description><identifier>ISSN: 1470-0328</identifier><identifier>EISSN: 1471-0528</identifier><identifier>DOI: 10.1111/1471-0528.14786</identifier><identifier>PMID: 28613432</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Birth control ; China - epidemiology ; Clinical outcomes ; Contraceptive Agents, Female - economics ; Contraceptive Agents, Female - therapeutic use ; Cost analysis ; Cost-Benefit Analysis - methods ; Cost-Benefit Analysis - statistics & numerical data ; Cost‐effectiveness ; Disease prevention ; Drug therapy ; Endometriosis ; Endometriosis - economics ; Endometriosis - epidemiology ; Endometriosis - therapy ; Female ; Gonadotropin-releasing hormone ; Gonadotropin-Releasing Hormone - agonists ; Gonadotropins ; gonadotropin‐releasing hormone agonist ; Health care expenditures ; Health Care Rationing ; Humans ; Laparoscopy ; Laparoscopy - adverse effects ; Laparoscopy - methods ; Laparotomy - adverse effects ; Laparotomy - methods ; Markov Chains ; Menopause ; Outcome Assessment, Health Care ; Peritoneum ; Pituitary (anterior) ; Quality-Adjusted Life Years ; Recurrence ; Remission ; Resource utilization ; Secondary Prevention - economics ; Secondary Prevention - methods ; Sensitivity analysis ; Socioeconomic Factors ; Surgery</subject><ispartof>BJOG : an international journal of obstetrics and gynaecology, 2018-03, Vol.125 (4), p.469-477</ispartof><rights>2017 Royal College of Obstetricians and Gynaecologists</rights><rights>2017 Royal College of Obstetricians and Gynaecologists.</rights><rights>Copyright © 2018 Royal College of Obstetricians and Gynaecologists</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4126-3c53d40bd9bd4be4afc329aa5883e7d6c9ed984d6fec8465cf533dabe7c4e3aa3</citedby><cites>FETCH-LOGICAL-c4126-3c53d40bd9bd4be4afc329aa5883e7d6c9ed984d6fec8465cf533dabe7c4e3aa3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28613432$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wu, B</creatorcontrib><creatorcontrib>Yang, Z</creatorcontrib><creatorcontrib>Tobe, RG</creatorcontrib><creatorcontrib>Wang, Y</creatorcontrib><title>Medical therapy for preventing recurrent endometriosis after conservative surgery: a cost‐effectiveness analysis</title><title>BJOG : an international journal of obstetrics and gynaecology</title><addtitle>BJOG</addtitle><description>Objective
To assess the cost‐effectiveness of different strategies, including gonadotropin‐releasing hormone agonist (GnRH‐a) and oral contraceptive therapy, for the prevention of endometriosis recurrence after conservative surgery.
Design
Cost‐effectiveness analysis from a health care perspective.
Setting
A health‐resource‐limited setting in China.
Population
Patients who underwent conservative laparoscopic or laparotomic surgery for endometriosis.
Methods
A Markov model was developed for the endometriosis disease course. Clinical data were obtained from published studies. Direct medical costs and resource utilization in the Chinese health care setting were taken into account. The health and economic outcomes were evaluated over a period from treatment initiation to menopause onset. Sensitivity analyses were carried out to test the impact of various parameters and assumptions on the model output.
Main outcome measures
Quality‐adjusted life years (QALYs) gained and costs from a health care perspective.
Results
The incremental cost‐effectiveness ratio of 6‐month GnRH‐a therapy compared with no therapy ranged from $6,185 per QALY in deep endometriosis to $6,425 with peritoneal endometriosis. A one‐way sensitivity analysis showed considerable influential factors, such as remission rates and utility values. Probabilistic sensitivity analysis indicated that 6‐month GnRH‐a therapy is cost‐effective in most cases at a threshold of $7,400/QALY, regardless of the type of endometriosis.
Conclusion
Six months of therapy with GnRH‐a can be a highly cost‐effective option for the prevention of endometriosis recurrence.
Tweetable
Gonadotropin‐releasing hormone agonist is cost effective for the prevention of endometriosis recurrence.
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Gonadotropin‐releasing hormone agonist is cost effective for the prevention of endometriosis recurrence.</description><subject>Birth control</subject><subject>China - epidemiology</subject><subject>Clinical outcomes</subject><subject>Contraceptive Agents, Female - economics</subject><subject>Contraceptive Agents, Female - therapeutic use</subject><subject>Cost analysis</subject><subject>Cost-Benefit Analysis - methods</subject><subject>Cost-Benefit Analysis - statistics & numerical data</subject><subject>Cost‐effectiveness</subject><subject>Disease prevention</subject><subject>Drug therapy</subject><subject>Endometriosis</subject><subject>Endometriosis - economics</subject><subject>Endometriosis - epidemiology</subject><subject>Endometriosis - therapy</subject><subject>Female</subject><subject>Gonadotropin-releasing hormone</subject><subject>Gonadotropin-Releasing Hormone - agonists</subject><subject>Gonadotropins</subject><subject>gonadotropin‐releasing hormone agonist</subject><subject>Health care expenditures</subject><subject>Health Care Rationing</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Laparoscopy - adverse effects</subject><subject>Laparoscopy - methods</subject><subject>Laparotomy - adverse effects</subject><subject>Laparotomy - methods</subject><subject>Markov Chains</subject><subject>Menopause</subject><subject>Outcome Assessment, Health Care</subject><subject>Peritoneum</subject><subject>Pituitary (anterior)</subject><subject>Quality-Adjusted Life Years</subject><subject>Recurrence</subject><subject>Remission</subject><subject>Resource utilization</subject><subject>Secondary Prevention - economics</subject><subject>Secondary Prevention - methods</subject><subject>Sensitivity analysis</subject><subject>Socioeconomic Factors</subject><subject>Surgery</subject><issn>1470-0328</issn><issn>1471-0528</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNqFkctO3DAUhi1UVG5ds6ssddNNGN_iJN0VxFWD2MDacuwTmlEmmR4nU2XHI_CMPAkOA7PoBm98fPz9v63_EHLM2QmPa8ZVxhOWivwkVrneIfvbzpe3miVMinyPHISwYIxrweRXsidyzaWSYp_gLfja2Yb2fwDtaqRVh3SFsIa2r9tHiuAGxHig0PpuCT3WXagDtVUPSF3XBsC17es10DDgI-D4i9rYD_3L0zNUFbjproUQJa1txqg9IruVbQJ8e98PycPF-f3ZVTK_u7w--z1PnOJCJ9Kl0itW-qL0qgRlKydFYW2a5xIyr10BvsiV1_GNXOnUVamU3paQOQXSWnlIfm58V9j9HSD0ZlkHB01jW-iGYHjBikyJTGcR_fEfuugGjP8NRjAmmOaKT9RsQznsQkCozArrpcXRcGamcZgpfDOFb97GERXf332Hcgl-y3_kH4F0A_yrGxg_8zOnN3cb41drUpiO</recordid><startdate>201803</startdate><enddate>201803</enddate><creator>Wu, B</creator><creator>Yang, Z</creator><creator>Tobe, RG</creator><creator>Wang, Y</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201803</creationdate><title>Medical therapy for preventing recurrent endometriosis after conservative surgery: a cost‐effectiveness analysis</title><author>Wu, B ; Yang, Z ; Tobe, RG ; Wang, Y</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4126-3c53d40bd9bd4be4afc329aa5883e7d6c9ed984d6fec8465cf533dabe7c4e3aa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Birth control</topic><topic>China - epidemiology</topic><topic>Clinical outcomes</topic><topic>Contraceptive Agents, Female - economics</topic><topic>Contraceptive Agents, Female - therapeutic use</topic><topic>Cost analysis</topic><topic>Cost-Benefit Analysis - methods</topic><topic>Cost-Benefit Analysis - statistics & numerical data</topic><topic>Cost‐effectiveness</topic><topic>Disease prevention</topic><topic>Drug therapy</topic><topic>Endometriosis</topic><topic>Endometriosis - economics</topic><topic>Endometriosis - epidemiology</topic><topic>Endometriosis - therapy</topic><topic>Female</topic><topic>Gonadotropin-releasing hormone</topic><topic>Gonadotropin-Releasing Hormone - agonists</topic><topic>Gonadotropins</topic><topic>gonadotropin‐releasing hormone agonist</topic><topic>Health care expenditures</topic><topic>Health Care Rationing</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Laparoscopy - adverse effects</topic><topic>Laparoscopy - methods</topic><topic>Laparotomy - adverse effects</topic><topic>Laparotomy - methods</topic><topic>Markov Chains</topic><topic>Menopause</topic><topic>Outcome Assessment, Health Care</topic><topic>Peritoneum</topic><topic>Pituitary (anterior)</topic><topic>Quality-Adjusted Life Years</topic><topic>Recurrence</topic><topic>Remission</topic><topic>Resource utilization</topic><topic>Secondary Prevention - economics</topic><topic>Secondary Prevention - methods</topic><topic>Sensitivity analysis</topic><topic>Socioeconomic Factors</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wu, B</creatorcontrib><creatorcontrib>Yang, Z</creatorcontrib><creatorcontrib>Tobe, RG</creatorcontrib><creatorcontrib>Wang, Y</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>BJOG : an international journal of obstetrics and gynaecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wu, B</au><au>Yang, Z</au><au>Tobe, RG</au><au>Wang, Y</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Medical therapy for preventing recurrent endometriosis after conservative surgery: a cost‐effectiveness analysis</atitle><jtitle>BJOG : an international journal of obstetrics and gynaecology</jtitle><addtitle>BJOG</addtitle><date>2018-03</date><risdate>2018</risdate><volume>125</volume><issue>4</issue><spage>469</spage><epage>477</epage><pages>469-477</pages><issn>1470-0328</issn><eissn>1471-0528</eissn><abstract>Objective
To assess the cost‐effectiveness of different strategies, including gonadotropin‐releasing hormone agonist (GnRH‐a) and oral contraceptive therapy, for the prevention of endometriosis recurrence after conservative surgery.
Design
Cost‐effectiveness analysis from a health care perspective.
Setting
A health‐resource‐limited setting in China.
Population
Patients who underwent conservative laparoscopic or laparotomic surgery for endometriosis.
Methods
A Markov model was developed for the endometriosis disease course. Clinical data were obtained from published studies. Direct medical costs and resource utilization in the Chinese health care setting were taken into account. The health and economic outcomes were evaluated over a period from treatment initiation to menopause onset. Sensitivity analyses were carried out to test the impact of various parameters and assumptions on the model output.
Main outcome measures
Quality‐adjusted life years (QALYs) gained and costs from a health care perspective.
Results
The incremental cost‐effectiveness ratio of 6‐month GnRH‐a therapy compared with no therapy ranged from $6,185 per QALY in deep endometriosis to $6,425 with peritoneal endometriosis. A one‐way sensitivity analysis showed considerable influential factors, such as remission rates and utility values. Probabilistic sensitivity analysis indicated that 6‐month GnRH‐a therapy is cost‐effective in most cases at a threshold of $7,400/QALY, regardless of the type of endometriosis.
Conclusion
Six months of therapy with GnRH‐a can be a highly cost‐effective option for the prevention of endometriosis recurrence.
Tweetable
Gonadotropin‐releasing hormone agonist is cost effective for the prevention of endometriosis recurrence.
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Gonadotropin‐releasing hormone agonist is cost effective for the prevention of endometriosis recurrence.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28613432</pmid><doi>10.1111/1471-0528.14786</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | BJOG : an international journal of obstetrics and gynaecology, 2018-03, Vol.125 (4), p.469-477 |
| issn | 1470-0328 1471-0528 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1909742767 |
| source | Wiley |
| subjects | Birth control China - epidemiology Clinical outcomes Contraceptive Agents, Female - economics Contraceptive Agents, Female - therapeutic use Cost analysis Cost-Benefit Analysis - methods Cost-Benefit Analysis - statistics & numerical data Cost‐effectiveness Disease prevention Drug therapy Endometriosis Endometriosis - economics Endometriosis - epidemiology Endometriosis - therapy Female Gonadotropin-releasing hormone Gonadotropin-Releasing Hormone - agonists Gonadotropins gonadotropin‐releasing hormone agonist Health care expenditures Health Care Rationing Humans Laparoscopy Laparoscopy - adverse effects Laparoscopy - methods Laparotomy - adverse effects Laparotomy - methods Markov Chains Menopause Outcome Assessment, Health Care Peritoneum Pituitary (anterior) Quality-Adjusted Life Years Recurrence Remission Resource utilization Secondary Prevention - economics Secondary Prevention - methods Sensitivity analysis Socioeconomic Factors Surgery |
| title | Medical therapy for preventing recurrent endometriosis after conservative surgery: a cost‐effectiveness analysis |
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