Arakawa Ichiro, Momoeda Mikio, Osuga Yutaka, Ota Ikuko, Koga Kaori
1Faculty of Pharmaceutical Sciences, Teikyo Heisei University, Tokyo, Japan.
Department of Obstetrics and Genecology, St. Luke International Hospital, Tokyo, Japan.
Cost Eff Resour Alloc. 2018 Apr 10;16:12. doi: 10.1186/s12962-018-0097-8. eCollection 2018.
This study aims to assess the cost-effectiveness of early physician consultation and guideline-based intervention to prevent endometriosis and/or disease progression using oral contraceptive (OC) and progestin compared to follow-up of self-care for dysmenorrhea in Japan.
A yearly-transmitted Markov model of five major health states with four sub-medical states was constructed. Transition probabilities among health and medical states were derived from Japanese epidemiological patient surveys and converted to appropriate parameters for inputting into the model. The dysmenorrhea and endometriosis-associated direct costs included inpatient, outpatient visit, surgery, and medication (OC agents, over-the-counter drugs), etc. The utility measure for patients with phase I-IV endometriosis comprised a visual analogue scale. We estimated the cost per quality-adjusted life year (QALY) at a time horizon of 23 years. An annual discount rate at 3% for both cost and outcome was considered.
The base case outcomes indicated that the intervention would be more cost-effective than self-care, as the incremental cost-effectiveness ratio (ICER) yielded 115,000 JPY per QALY gained from the healthcare payers' perspective and the societal monetary value (SMV) was approximately positive 3,130,000 JPY, favoring the intervention in the cost-benefit estimate. A tornado diagram depicting the stochastic sensitivity analysis of the ICER and SMV from both the healthcare payers' and societal perspectives confirmed the robustness of the base case. A probabilistic analysis resulting from 10,000-time Monte Carlo simulations demonstrated efficiency at willingness-to-pay thresholds in more than 90% of the iterations.
The present analysis demonstrated that early physician consultation and guideline-based intervention would be more cost-effective than self-care in preventing endometriosis and/or disease progression for patients with dysmenorrhea in Japan.
本研究旨在评估在日本，与痛经自我护理随访相比，早期医生咨询及基于指南的干预措施（使用口服避孕药（OC）和孕激素）预防子宫内膜异位症和/或疾病进展的成本效益。
构建了一个具有五个主要健康状态和四个亚医学状态的年度传播马尔可夫模型。健康和医学状态之间的转移概率来自日本流行病学患者调查，并转换为适合输入模型的参数。痛经和子宫内膜异位症相关的直接成本包括住院、门诊就诊、手术和药物治疗（OC制剂、非处方药）等。I-IV期子宫内膜异位症患者的效用测量采用视觉模拟量表。我们在23年的时间范围内估计了每质量调整生命年（QALY）的成本。成本和结果均考虑3%的年度贴现率。
基础病例结果表明，该干预措施比自我护理更具成本效益，从医疗保健支付者的角度来看，每获得一个QALY的增量成本效益比（ICER）为115,000日元，社会货币价值（SMV）约为正3,130,000日元，在成本效益估计中支持该干预措施。从医疗保健支付者和社会角度描绘ICER和SMV随机敏感性分析的龙卷风图证实了基础病例的稳健性。10,000次蒙特卡洛模拟产生的概率分析表明，在超过90%的迭代中，支付意愿阈值下具有效率。
本分析表明，在日本，对于痛经患者，早期医生咨询及基于指南的干预措施在预防子宫内膜异位症和/或疾病进展方面比自我护理更具成本效益。
