Cost-effectiveness of long-acting progestogens versus the combined oral contraceptives pill for preventing recurrence of endometriosis-related pain following surgery: an economic evaluation alongside the PRE-EMPT trial
Objectives To evaluate the cost-effectiveness of long-acting progestogens (LAP), including levonorgestrel-releasing intrauterine system (LNG-IUS) and depot-medroxyprogesterone acetate (DMPA), compared with the combined oral contraceptives pill (COCP) in preventing recurrence of endometriosis-related...
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BMJ Publishing Group
2024-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/12/e088072.full |
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| author | Tracy E Roberts Mark Monahan Lee Middleton Siladitya Bhattacharya Versha Cheed Jane P Daniels Kevin G Cooper Melyda Melyda |
| author_facet | Tracy E Roberts Mark Monahan Lee Middleton Siladitya Bhattacharya Versha Cheed Jane P Daniels Kevin G Cooper Melyda Melyda |
| author_sort | Tracy E Roberts |
| collection | DOAJ |
| description | Objectives To evaluate the cost-effectiveness of long-acting progestogens (LAP), including levonorgestrel-releasing intrauterine system (LNG-IUS) and depot-medroxyprogesterone acetate (DMPA), compared with the combined oral contraceptives pill (COCP) in preventing recurrence of endometriosis-related pain postsurgery.Design Within-trial economic evaluation alongside a multicentre, pragmatic, parallel-group, open-label, randomised controlled trial (Preventing Recurrence of Endometriosis by means of Long-Acting Progestogen Therapy trial).Setting Thirty-four UK hospitals recruiting participants from November 2015 to March 2019.Patients Four hundred and five women aged 16–45 years undergoing conservative endometriosis surgery.Interventions The ratio of 1:1 randomisation to receive LAPs (LNG-IUS or DMPA) or COCP.Main outcome measures The primary evaluation was a cost-utility analysis based on cost per quality-adjusted life-year (QALY) gained at 3 years. We adopted a UK National Health Service perspective. Secondary analyses in the form of cost-effectiveness analysis based on a range of outcomes were also undertaken.Results For the primary analysis, the COCP group incurred an additional cost of £533 (95% CI £52 to £983) per woman compared with LAPs. Treatment with COCP generated additional QALYs of 0.031 (95% CI −0.079 to 0.139) compared with the LAP group over 36-month follow-up. The incremental cost-effectiveness ratio for COCP compared with LAPs is therefore approximately £17 193 per QALY. The probabilistic sensitivity analysis suggested that there was a 54.7% probability that COCP would be cost-effective at the £20 000/QALY threshold. The secondary analyses revealed results more in favour of LAPs.Conclusion Although the COCP has a slightly higher probability of being cost-effective at £20 000/QALY threshold, there remains considerable uncertainty, with only marginal differences in outcomes between the two treatments. The lower rates of further surgery and second-line medical treatment for women allocated to LAPs may make this option preferable for some women.Trial registration number ISRCTN 97865475. |
| format | Article |
| id | doaj-art-bd41ab5b0ae3480da750c7b3c27f919a |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-bd41ab5b0ae3480da750c7b3c27f919a2024-12-17T11:15:11ZengBMJ Publishing GroupBMJ Open2044-60552024-12-01141210.1136/bmjopen-2024-088072Cost-effectiveness of long-acting progestogens versus the combined oral contraceptives pill for preventing recurrence of endometriosis-related pain following surgery: an economic evaluation alongside the PRE-EMPT trialTracy E Roberts0Mark Monahan1Lee Middleton2Siladitya Bhattacharya3Versha Cheed4Jane P Daniels5Kevin G Cooper6Melyda Melyda71 Health Economics Unit, Department of Applied Health Science, College of Medicine and Health, University of Birmingham, Birmingham, B15 2TT, UK1 Health Economics Unit, Department of Applied Health Science, College of Medicine and Health, University of Birmingham, Birmingham, B15 2TT, UK5 Birmingham Clinical Trials Unit, College of Medicine and Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK3 School of Medicine Medical Sciences & Nutrition, University of Aberdeen, Foresterhill, Aberdeen, AB24 3FX, UK5 Birmingham Clinical Trials Unit, College of Medicine and Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK4 Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, NG7 2RD, UK2 NHS Grampian, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK1 Health Economics Unit, Department of Applied Health Science, College of Medicine and Health, University of Birmingham, Birmingham, B15 2TT, UKObjectives To evaluate the cost-effectiveness of long-acting progestogens (LAP), including levonorgestrel-releasing intrauterine system (LNG-IUS) and depot-medroxyprogesterone acetate (DMPA), compared with the combined oral contraceptives pill (COCP) in preventing recurrence of endometriosis-related pain postsurgery.Design Within-trial economic evaluation alongside a multicentre, pragmatic, parallel-group, open-label, randomised controlled trial (Preventing Recurrence of Endometriosis by means of Long-Acting Progestogen Therapy trial).Setting Thirty-four UK hospitals recruiting participants from November 2015 to March 2019.Patients Four hundred and five women aged 16–45 years undergoing conservative endometriosis surgery.Interventions The ratio of 1:1 randomisation to receive LAPs (LNG-IUS or DMPA) or COCP.Main outcome measures The primary evaluation was a cost-utility analysis based on cost per quality-adjusted life-year (QALY) gained at 3 years. We adopted a UK National Health Service perspective. Secondary analyses in the form of cost-effectiveness analysis based on a range of outcomes were also undertaken.Results For the primary analysis, the COCP group incurred an additional cost of £533 (95% CI £52 to £983) per woman compared with LAPs. Treatment with COCP generated additional QALYs of 0.031 (95% CI −0.079 to 0.139) compared with the LAP group over 36-month follow-up. The incremental cost-effectiveness ratio for COCP compared with LAPs is therefore approximately £17 193 per QALY. The probabilistic sensitivity analysis suggested that there was a 54.7% probability that COCP would be cost-effective at the £20 000/QALY threshold. The secondary analyses revealed results more in favour of LAPs.Conclusion Although the COCP has a slightly higher probability of being cost-effective at £20 000/QALY threshold, there remains considerable uncertainty, with only marginal differences in outcomes between the two treatments. The lower rates of further surgery and second-line medical treatment for women allocated to LAPs may make this option preferable for some women.Trial registration number ISRCTN 97865475.https://bmjopen.bmj.com/content/14/12/e088072.full |
| spellingShingle | Tracy E Roberts Mark Monahan Lee Middleton Siladitya Bhattacharya Versha Cheed Jane P Daniels Kevin G Cooper Melyda Melyda Cost-effectiveness of long-acting progestogens versus the combined oral contraceptives pill for preventing recurrence of endometriosis-related pain following surgery: an economic evaluation alongside the PRE-EMPT trial BMJ Open |
| title | Cost-effectiveness of long-acting progestogens versus the combined oral contraceptives pill for preventing recurrence of endometriosis-related pain following surgery: an economic evaluation alongside the PRE-EMPT trial |
| title_full | Cost-effectiveness of long-acting progestogens versus the combined oral contraceptives pill for preventing recurrence of endometriosis-related pain following surgery: an economic evaluation alongside the PRE-EMPT trial |
| title_fullStr | Cost-effectiveness of long-acting progestogens versus the combined oral contraceptives pill for preventing recurrence of endometriosis-related pain following surgery: an economic evaluation alongside the PRE-EMPT trial |
| title_full_unstemmed | Cost-effectiveness of long-acting progestogens versus the combined oral contraceptives pill for preventing recurrence of endometriosis-related pain following surgery: an economic evaluation alongside the PRE-EMPT trial |
| title_short | Cost-effectiveness of long-acting progestogens versus the combined oral contraceptives pill for preventing recurrence of endometriosis-related pain following surgery: an economic evaluation alongside the PRE-EMPT trial |
| title_sort | cost effectiveness of long acting progestogens versus the combined oral contraceptives pill for preventing recurrence of endometriosis related pain following surgery an economic evaluation alongside the pre empt trial |
| url | https://bmjopen.bmj.com/content/14/12/e088072.full |
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