The Most Cost Effective Medical Treatment to Prevent Recurrent Endometriosis

Gonadotropin-releasing hormone agonist therapy is more cost effective than oral contraceptives to prevent recurrence.

Key Points

Highlights:

• Gonadotropin-releasing hormone agonist (GnRH-a) therapy is more cost effective than oral contraceptives for the treatment of recurrent endometriosis after conservative surgery, despite being more expensive.

Importance:

• Recurrence after surgery for endometriosis is high. Oral contraceptives or Gonadotropin-releasing hormone agonist (GnRH-a) may be used for prevention of recurrence.
• In the literature, GnRH-a was superior to expectant or placebo treatment, or compared to oral contraceptive therapy, in the prevention of recurrences, but is more expensive.
• The results of this study could help clinicians and patients worldwide decide which type of drug to use for the prevention of recurrent endometriosis after conservative surgery.

What’s done here?

• The cost-effectiveness of no treatment, treatment with oral contraceptives, and treatment with GnRH-a for three and six months considered in women who underwent conservative surgery after the first diagnosis of endometriosis, using a mathematical model.

Key results:

• Both three and six months of treatment with GnRH-a were found to be cost effective
• Six months GnRH-a therapy yielded better clinical outcomes than the three months treatment.
• Oral contraceptive therapy was not seen to be cost-effective in spite of its lower monthly cost.

Limitations of the study:

• Only the Chinese health system considered for the study.
• Only the direct cost of the drugs evaluated, and no indirect costs such as work productivity or quality of life taken into account.
• The data were obtained from public sources with a high degree of heterogeneity due to different study design, patient characteristics and dosing schedules.
• The mathematical model did not take into account future therapeutic changes, which might modify the risk of endometriosis.
• The potential adverse effects of using GnRH-a beyond six months not considered.

Lay Summary

A new study conducted in China found that a class of drugs called Gonadotropin-releasing hormone agonists (GnRH-a) is more cost effective for the treatment of recurrent endometriosis despite the fact that they are more expensive than oral contraceptives.

The results of the study published in An International Journal of Obstetrics & Gynaecology could help clinicians and patients worldwide to decide which drug to choose as a first-line treatment for the prevention of endometriosis.

Researchers led by Dr. Yu Wang at  Shanghai Jiaotong University in China considered the cost-effectiveness of four approaches to prevent recurrent endometriosis after surgery: 1) no treatment; 2) treatment with oral contraceptives; 3) treatment with GnRH-a for three months and 4) treatment with GnRH-a for six months. 

The data obtained from several long-term cohort studies conducted in China, which included women who underwent surgery after the first diagnosis of endometriosis and experienced one of the treatment options above.

The authors devised a mathematical model calculating the cost effectiveness of each therapy regarding the cost of treatment adjusted for the quality of life in the years after the treatment.  If the corrected yearly cost was lower than the gross domestic product (GDP) of China per capita, the approach was considered cost effective. Such an approach is in agreement with the recommendations of the World Health Organization (WHO). 

The study found that both three and six months treatment with GnRH-a were profitable but that the six months GnRH-a therapy yielded better clinical outcomes. Conversely, the oral contraceptive therapy was not cost-effective in spite to its lower monthly cost. 

It is important to note that although both GnRH-a and oral contraceptives reduce fertility and are called ‘hormone treatment,' they work in very different ways. GnRH-a suppresses the production of the female hormone estrogen decreasing the growth of endometriosis tissue while oral contraceptives contain synthetic versions of estrogen and progesterone making periods less cumbersome and less painful. 

Although results obtained considering the Chinese health system, they might provide a reference for other medium-income countries, such as Brazil, Russia, Taiwan, and Thailand, as well as to clinicians in other countries.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/28613432