A cost-effectiveness analysis of vaginal carbon dioxide laser therapy compared with standard medical therapies for genitourinary syndrome of menopause-associated dyspareunia

Wallace, Shannon L.; Martin, Brad St.; Lee, Kyueun; Sokol, Eric R.

doi:10.1016/j.ajog.2020.06.032

Cited by 19 publications

(20 citation statements)

References 47 publications

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“…In addition, Treeage software is a commonly used and specialized software for cost‐effectiveness analyses. Thus, we built the decision tree and Markov model according to relevant literature 33‐35 …”

Section: Discussionmentioning

confidence: 99%

Cost‐effectiveness analysis of first‐line treatments for advanced epidermal growth factor receptor‐mutant non‐small cell lung cancer patients

Chai

et al. 2021

Cancer Medicine

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Objectives Recent studies showed prolonged survival for advanced epidermal growth factor receptor (EGFR)‐mutant non‐small cell lung cancer (NSCLC) patients treated with both monotherapies and combined therapies. However, high costs limit clinical applications. Thus, we conducted this cost‐effectiveness analysis to explore an optimal first‐line treatment for advanced EGFR‐mutant NSCLC patients. Materials and Methods Survival data were extracted from six clinical trials, including ARCHER1050 (dacomitinib vs. gefitinib); FLAURA (osimertinib vs. gefitinib/erlotinib); JO25567 and NEJ026 (bevacizumab +erlotinib vs. erlotinib); NEJ009 (gefitinib +chemotherapy vs. gefitinib); and NCT02148380 (gefitinib +chemotherapy vs. gefitinib vs. chemotherapy) trials. Cost‐related data were obtained from hospitals and published literature. The effect parameter (quality‐adjusted life year [QALY]) was the reflection of both survival and utility. Incremental cost‐effectiveness ratio (ICER), average cost‐effectiveness ratio (ACER), and net benefit were calculated, and the willingness‐to‐pay (WTP) threshold was set at $30828/QALY from the perspective of the Chinese healthcare system. Sensitivity analysis was performed to explore the stability of results. Results We compared treatment groups with control groups in each trial. ICERs were $1897750.74/QALY (ARCHER1050), $416560.02/QALY (FLAURA), ‐$477607.48/QALY (JO25567), ‐$464326.66/QALY (NEJ026), ‐$277121.22/QALY (NEJ009), ‐$399360.94/QALY (gefitinib as comparison, NCT02148380), and ‐$170733.05/QALY (chemotherapy as comparison, NCT02148380). Moreover, ACER and net benefit showed that the combination of EGFR‐TKI with chemotherapy and osimertinib was of more economic benefit following first‐generation EGFR‐TKIs. Sensitivity analyses showed that the impact of utilities and monotherapy could be cost‐effective with a 50% cost reduction. Conclusion First‐generation EGFR‐TKI therapy remained the most cost‐effective treatment option for advanced EGFR‐mutant NSCLC patients. Our results could serve as both a reference for both clinical practice and the formulation of medical insurance reimbursement.

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Section: Discussionmentioning

confidence: 99%

Cost‐effectiveness analysis of first‐line treatments for advanced epidermal growth factor receptor‐mutant non‐small cell lung cancer patients

Chai

et al. 2021

Cancer Medicine

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“…The study by Wallace et al [34] previously discussed found that there was less probability of side effects or complications when using CO 2 vaginal laser therapy compared to vaginal estrogen. Additionally, in a prospective cohort study conducted by Donato et al [35] (N=53) to evaluate satisfaction and safety of treatment of GSM with CO 2 vaginal laser therapy, only acute and minor complications were reported including minor bleeding with insertion of the treatment probe and dysuria.…”

Section: Safety Of Energy-based Devicesmentioning

confidence: 98%

“…In addition to their promising efficacy, the energy-based devices have been shown to be cost-effective, and do not require sedation or downtime for patients. Wallace et al [34] conducted a retrospective review study in 2020 comparing the cost-effectiveness of vaginal estrogen, ospemifene, and vaginal CO 2 laser therapy. All treatments were found to be costeffective; however, they found vaginal CO 2 laser therapy to be the most cost-effective when assuming the following based on published data in their review of the research: typical adherence rates of the three treatment options, efficacy of the treatments, and patient costs for each treatment.…”

Section: Energy-based Interventionsmentioning

confidence: 99%

“…While the findings are promising for the energy-based devices, it must be mentioned that the typical adherence rate for vaginal CO 2 laser therapy was assumed based on adherence rates to other inoffice procedures such as percutaneous tibial nerve stimulation and on data from RCTs which is significant given the fact that the researchers found that the variable that most influenced the cost-effectiveness results was adherence to the treatment regimen. Additionally, the cost of each treatment was estimated based only on patient cost and did not evaluate physician office and hospital costs [34].…”

Section: Energy-based Interventionsmentioning

confidence: 99%

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Energy-Based Devices for Functional Vaginal Problems: Issues and Answers

Bujnak

Crowder

Krychman

2021

Curr Sex Health Rep

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Vaginal rejuvenation is a marketing term that encompasses surgical and medical treatments for functional vaginal/vulvar problems including but not limited to genitourinary syndrome of menopause (GSM), sexual dysfunction, vaginal laxity, and stress urinary incontinence (SUI) and for esthetic concerns including dissatisfaction with vulvovaginal appearance. Multiple treatment options have become available for indications of functional vaginal problems. Noninvasive management options including the use of more novel treatments such as energy-based devices have gained interest. Previously, studies regarding the efficacy and safety of the energy-based devices for functional vaginal problems were mostly limited to cohort studies without sham treatment, control groups, randomization, or double blinding. As a result of this insufficient data in 2018, the FDA released a statement of warning against the use of energy-based devices in the treatment of functional vaginal problems or vaginal cosmetic procedures (Https://Www.Fda.Gov/Medical-Devices/Safety-Communications/Fda-Warns-Against-Use-Energy-Based-Devices-Perform-Vaginal-Rejuvenation-or-Vaginal-Cosmetic. 1–4, 2018). Purpose of Review This article reviews the most current treatment modalities in the realm of vaginal rejuvenation therapy with an emphasis on the efficacy and safety of the energy-based devices. Recent Findings In the most recent literature, there have been studies with improvements in study design that support the efficacy and the short-term safety of the energy-based devices. Summary More recent studies with improved study design evidence that the use of energy-based devices results in improvements in functional vaginal problems and that serious adverse events appear to be rare. The availability of these devices as treatment options for functional vaginal problems has the potential to impact patient by improving their symptoms and quality of life. Caution still remains however regarding their safety following a longer period of time after their use.

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“…They found significant improvements in the VHI (Vaginal Health Index), which clinically evaluates vulvovaginal atrophy, and the VAS (Visual Analog Scale) which evaluates symptoms of GSM [82] . In a retrospective study conducted in 2020 found that vaginal CO 2 laser therapy emerged as the most cost-effective treatment as compared to vaginal estrogen therapy and ospemifene therapy [83] .…”

Section: Carbon Dioxide Lasermentioning

confidence: 99%

Cosmetic Gynecology: Present and Future Perspectives

Mishra

Mihai²,

Khurana³

et al. 2021

ijirms

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Postmenopausal women and events like childbirth, and aging may cause structural and functional changes in women genitalia. The arising indications do not only cause psychological distress to women but negatively affect the sexual well-being and deteriorate the quality of their lives. Regenerative/ cosmetic gynecology procedures enable women to treat the functionality issues and modify the physical structure of vagina. This review discusses the latest developments in this field with regards to various kinds of procedures that are available, particularly the use of energy-based devices, and adipose tissue derived stem cells therapy for fat grafting which have revolutionized the regenerative gynecology procedures. These offer non-invasive modalities to treat the conditions like urinary incontinence among others which occur in high prevalence among women. Despite the advancements made in this field, it lacks regulatory guidelines and standardized procedures which imposes one of the biggest challenges of the field. Alongside, we have documented a procedure called Intimacell® which has been standardized for fat grafting procedures in vulvovaginal region.

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A cost-effectiveness analysis of vaginal carbon dioxide laser therapy compared with standard medical therapies for genitourinary syndrome of menopause-associated dyspareunia

Cited by 19 publications

References 47 publications

Cost‐effectiveness analysis of first‐line treatments for advanced epidermal growth factor receptor‐mutant non‐small cell lung cancer patients

Cost‐effectiveness analysis of first‐line treatments for advanced epidermal growth factor receptor‐mutant non‐small cell lung cancer patients

Energy-Based Devices for Functional Vaginal Problems: Issues and Answers

Cosmetic Gynecology: Present and Future Perspectives

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