RFA should more often be considered a relevant treatment option both from an economic and a medical point of view.

ObjectiveTo evaluate the economic and clinical benefits of endometrial radiofrequency ablation (RFA) compared with other ablation techniques for the treatment of menorrhagia.MethodsUsing German health claims data, women meeting defined inclusion criteria for the intervention group (RFA) were selected. A comparable control group (other endometrial ablations) was established using propensity score matching. These two groups were compared during the quarter of treatment (QoT) and a follow-up of 2 years for the following outcomes: costs during QoT and during follow-up, repeated menorrhagia diagnoses during follow-up and necessary retreatments during follow-up.ResultsAfter performing propensity score matching, 50 cases could be allocated to the intervention group, while 38 were identified as control cases. Patients in the RFA group had 5% fewer repeat menorrhagia diagnoses (40% vs 45%; not significant) and 5% fewer treatments associated with recurrent menorrhagia (6% vs 11%; not significant) than cases in the control group. During the QoT, the RFA group incurred €578 additional costs (€2,068 vs €1,490; ns). However, during follow-up, the control group incurred €1,254 additional costs (€4,561 vs €5,815; ns), with medication, outpatient physician consultations, and hospitals costs being the main cost drivers. However, none of the results were statistically significant.ConclusionAlthough RFA was more cost-intensive in the QoT compared with other endometrial ablation techniques, an average total savings of €676 was generated during the follow-up period. While having evidence that RFA is clinically equivalent to other endometrial ablation procedures, we generated indications that RFA is non-inferior and favorable with regard to economic outcomes.

disease data. In the absence of comparative clinical evidence, Duodopa and Apomorphine were assumed to have equivalent efficacy to DBS. The cost analysis covered: device acquisition, implantation, adverse event management, concomitant drug use, device replacements and follow-up. Cost data were taken from Swedish tariffs, drug list prices and device prices. Costs and QALYs were both discounted at 3% per year. Results: The incremental cost-effectiveness ratio for DBS versus BMT was SEK 387,313 per QALY gained, using a time horizon of 15 years. DBS was predicted to be cost-saving versus Duodopa at 5 years (with a saving of SEK 534,000 per patient) and at 10 years versus Apomorphine. The key parameters in the model were the costs of the DBS device components and the unit costs of the advanced drug therapies. ConClusions: The results suggest that DBS is a cost-effective intervention compared with BMT, based on the informal threshold used in Sweden (SEK 500,000 per QALY gained). When compared against Apomorphine and Duodopa, the high initial costs of DBS equipment and implantation are offset in the long-term by reduced medication costs.