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

ObjectiveTo 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. DesignCost-effectiveness analysis from a health care perspective. SettingA health-resource-limited setting in China. PopulationPatients who underwent conservative laparoscopic or laparotomic surgery for endometriosis. MethodsA 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 measuresQuality-adjusted life years (QALYs) gained and costs from a health care perspective. ResultsThe 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. ConclusionSix months of therapy with GnRH-a can be a highly cost-effective option for the prevention of endometriosis recurrence. Tweetable abstractGonadotropin-releasing hormone agonist is cost effective for the prevention of endometriosis recurrence. Tweetable abstract Gonadotropin-releasing hormone agonist is cost effective for the prevention of endometriosis recurrence.