QualityMetric Incorporated, Lincoln, Rhode Island 02865, USA.
Appl Health Econ Health Policy. 2010;8(2):129-40. doi: 10.2165/11532210-000000000-00000.
Premenstrual syndrome (PMS) is reported to affect between 13% and 31% of women. Between 3% and 8% of women are reported to meet criteria for the more severe form of PMS, premenstrual dysphoric disorder (PMDD). Although PMDD has received increased attention in recent years, the cost effectiveness of treatments for PMDD remains unknown.
To evaluate the cost effectiveness of the four medications with a US FDA-approved indication for PMDD: fluoxetine, sertraline, paroxetine and drospirenone plus ethinyl estradiol (DRSP/EE).
A decision-analytic model was used to evaluate both direct costs (medication and physician visits) and clinical outcomes (treatment success, failure and discontinuation). Medication costs were based on average wholesale prices of branded products; physician visit costs were obtained from a claims database study of PMDD patients and the Agency for Healthcare Research and Quality. Clinical outcome probabilities were derived from published clinical trials in PMDD. The incremental cost-effectiveness ratio (ICER) was calculated using the difference in costs and percentage of successfully treated patients at 6 months. Deterministic and probabilistic sensitivity analyses were used to assess the impact of uncertainty in parameter estimates. Threshold values where a change in the cost-effective strategy occurred were identified using a net benefit framework.
Starting therapy with DRSP/EE dominated both sertraline and paroxetine, but not fluoxetine. The estimated ICER of initiating treatment with fluoxetine relative to DRSP/EE was $US4385 per treatment success (year 2007 values). Cost-effectiveness acceptability curves revealed that for ceiling ratios>or=$US3450 per treatment success, fluoxetine had the highest probability (>or=0.37) of being the most cost-effective treatment, relative to the other options. The cost-effectiveness acceptability frontier further indicated that DRSP/EE remained the option with the highest expected net monetary benefit for ceiling values <or=$US3900 per treatment success.
These analyses suggest that initiating therapy with DRSP/EE may be a cost-effective option in the treatment of PMDD.
经报道，经前期综合征（PMS）影响 13%至 31%的女性。有 3%至 8%的女性符合更严重的经前期烦躁障碍（PMDD）的诊断标准。尽管近年来 PMDD 受到了更多关注，但治疗 PMDD 的成本效益仍不清楚。
评估四种经美国食品和药物管理局批准用于 PMDD 的药物的成本效益：氟西汀、舍曲林、帕罗西汀和屈螺酮加炔雌醇（DRSP/EE）。
使用决策分析模型评估直接成本（药物和医生就诊）和临床结局（治疗成功、失败和停药）。药物成本基于品牌产品的平均批发价格；医生就诊费用来自一项针对 PMDD 患者的索赔数据库研究和美国医疗保健研究与质量局。临床结局概率源自 PMDD 的已发表临床试验。使用 6 个月时成功治疗患者的比例和成本差异计算增量成本效益比（ICER）。使用确定性和概率敏感性分析来评估参数估计不确定性的影响。使用净收益框架确定成本效益策略发生变化的阈值值。
以 DRSP/EE 开始治疗优于舍曲林和帕罗西汀，但不如氟西汀。与 DRSP/EE 相比，开始氟西汀治疗的估计 ICER 为每治疗成功增加 4385 美元（2007 年值）。成本效益接受性曲线表明，对于上限比>或=3450 美元/治疗成功，氟西汀相对于其他选择，具有成为最具成本效益治疗方法的最高概率（>或=0.37）。成本效益接受性前沿进一步表明，对于上限值<或=3900 美元/治疗成功，DRSP/EE 仍然是具有最高预期净货币收益的选择。
这些分析表明，以 DRSP/EE 开始治疗可能是 PMDD 治疗的一种具有成本效益的选择。
