Repeated intermittent ulipristal acetate in the treatment of uterine fibroids: a cost-effectiveness analysis

Abstract

Kirk Geale,1,2 Ertan Saridogan,3 Matthieu Lehmann,4 Pablo Arriagada,4 Marcus Hultberg,2 Martin Henriksson5 1Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; 2PAREXEL International, Stockholm, Sweden; 3Women’s Health Division, University College London Hospital, London, UK; 4PregLem SA, Geneva, Switzerland; 5Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Abstract: There are limited treatment options available for women with moderate to severe symptoms of uterine fibroids (UFs) who wish to avoid surgery. For these women, treatment with standard pharmaceuticals such as contraceptives is often insufficient to relieve symptoms, and patients may require surgery despite their wish to avoid it. Clinical trials demonstrate that ulipristal acetate 5 mg (UPA) is an effective treatment for this patient group, but its cost-effectiveness has not been assessed in this population. A decision-analytic model was developed to simulate a cohort of patients in this population under treatment with UPA followed by surgery as needed compared to treatment with iron and non-steroidal anti-inflammatory drug (NSAID) followed by surgery as needed (best supportive care, BSC). The analysis took the perspective of the National Health Service (NHS) in England, UK, and was based on the published UPA clinical trials. Results were calculated for the long-term costs and quality-adjusted life years (QALYs) for each treatment arm and combined into an incremental cost-effectiveness ratio (ICER) as the primary outcome. The impact of parameter uncertainty on the results was assessed using scenario, deterministic, and probabilistic sensitivity analyses. The results show that treating patients with the UPA strategy, instead of the BSC strategy, results in an additional cost of £1,115 and a gain of 0.087 QALYs, resulting in an ICER of £12,850. Given commonly accepted cost-effectiveness thresholds in England, the use of UPA as a repeated, intermittent treatment for women with moderate to severe symptoms of UF wishing to avoid surgery is likely to be a cost-effective intervention when compared to BSC. Keywords: uterine fibroids, cost-effectiveness, health economics, ulipristal acetate, economic evaluation

Keywords

• uterine fibroids
• cost-effectiveness
• health economics
• ulipristal acetate
• economic evaluation