Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
BJOG. 2018 Mar;125(4):469-477. doi: 10.1111/1471-0528.14786. Epub 2017 Jul 26.
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.
Cost-effectiveness analysis from a health care perspective.
A health-resource-limited setting in China.
Patients who underwent conservative laparoscopic or laparotomic surgery for endometriosis.
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.
Quality-adjusted life years (QALYs) gained and costs from a health care perspective.
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.
Six months of therapy with GnRH-a can be a highly cost-effective option for the prevention of endometriosis recurrence.
Gonadotropin-releasing hormone agonist is cost effective for the prevention of endometriosis recurrence.
评估不同策略（包括促性腺激素释放激素激动剂（GnRH-a）和口服避孕药治疗）预防保守手术后子宫内膜异位症复发的成本效益。
从医疗保健角度进行成本效益分析。
中国资源有限的医疗保健环境。
接受过腹腔镜或剖腹手术治疗子宫内膜异位症的患者。
为子宫内膜异位症疾病过程开发了一个 Markov 模型。临床数据来自已发表的研究。考虑了中国医疗保健环境中的直接医疗成本和资源利用。健康和经济结果在从治疗开始到绝经开始的一段时间内进行评估。进行敏感性分析以测试各种参数和假设对模型输出的影响。
从医疗保健角度获得的质量调整生命年（QALY）和成本。
与无治疗相比，6 个月 GnRH-a 治疗的增量成本效益比从深部子宫内膜异位症的每 QALY6185 美元到腹膜子宫内膜异位症的每 QALY6425 美元不等。单向敏感性分析显示了相当大的影响因素，如缓解率和效用值。概率敏感性分析表明，无论子宫内膜异位症的类型如何，6 个月 GnRH-a 治疗在大多数情况下在 7400 美元/QALY 的阈值下都是具有成本效益的。
GnRH-a 治疗 6 个月可作为预防子宫内膜异位症复发的一种极具成本效益的选择。
