The cost-effectiveness of ulipristal acetate tablets in treating patients with moderate to severe symptoms of uterine fibroids

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 175; pp. 75 - 81
• Main Authors: Nagy, Balázs, Timár, György, Józwiak-Hagymásy, Judit, Kovács, Gábor, Merész, Gergő, Vámossy, István, Ágh, Tamás, László, Ádám, Vokó, Zoltán, Kaló, Zoltán
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.04.2014
• Subjects: Adult; Cost-Benefit Analysis; Cost-effectiveness; Cost-utility analysis; Economic evaluation; Female; Humans; Leiomyoma - drug therapy; Leiomyoma - economics; Leiomyoma - surgery; Models, Economic; Norpregnadienes - economics; Norpregnadienes - therapeutic use; Obstetrics and Gynecology; Ulipristal acetate; Uterine Neoplasms - drug therapy; Uterine Neoplasms - economics; Uterine Neoplasms - surgery; Cost-utility analysis; Cost-effectiveness; Ulipristal acetate; Economic evaluation
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2014.01.022

Abstract Objectives Ulipristal acetate is a selective progesterone receptor modulator that has been demonstrated to be an effective 3-month pre-operative treatment for moderate to severe symptoms of uterine fibroids in adult women of reproductive age. The aim of this analysis was to assess the cost-effectiveness of 5 mg ulipristal as an add-on therapy to standard pre-surgical observation and treatment in Hungary. Study design A Markov model was developed using a 10-year time horizon. Ulipristal was compared with pre-surgical observation and immediate hysterectomy. The model comprised the following mutually exclusive health states: mild, moderate, severe, or persistent severe excessive bleeding disorder; myomectomy; post-myomectomy with mildly to moderately excessive bleeding disorder; post-myomectomy with severely excessive bleeding disorder; hysterectomy; post-hysterectomy; post-menopause; and death. Transition probabilities and utility values were obtained from clinical trials and the scientific literature. Resource utilisation and unit costs were derived from a consensus panel of clinical experts, National Health Insurance Fund tariffs, and publications. Results Adding a 3-month course of ulipristal to pre-operative observation was predicted to achieve an additional 0.021 quality-adjusted life years (QALYs) at an estimated incremental cost of €397, which would result in an incremental cost of €19,200/QALY. When 3 months of ulipristal therapy was compared with immediate hysterectomy, the incremental cost-effectiveness ratio was reduced to €3575/QALY. The results were most sensitive to the utility value of the post-hysterectomy health state but responsive to changes in other model parameters. Conclusions The results of this analysis suggest that adding ulipristal treatment to standard pre-surgical therapy represents a good value for money in Hungary. The inclusion of societal benefits may considerably reduce the cost-effectiveness ratio.