Incorporating ulipristal acetate in the care of symptomatic uterine fibroids: a Canadian cost-utility analysis of pharmacotherapy management

Abstract

ObjectiveTo present a Canadian economic evaluation on the cost-utility of ulipristal acetate (5 mg orally daily) compared to leuprolide acetate (3.75 mg intramuscular monthly) in the treatment of moderate-to-severe symptoms of uterine fibroids in women eligible for surgery.MethodsA probabilistic decision tree was constructed to model the pre-operative pharmacological management of uterine fibroids under the primary perspective of the Ontario public payer. The model parameterized data from clinical trials, observational studies, and public costing databases. The outcome measure was the incremental cost-utility ratio. Uncertainty in the model was explored through sensitivity and scenario analyses.ResultsUlipristal was associated with faster control of excessive menstrual bleeding, fewer symptoms of hot flashes and lower health care resource consumption. The ulipristal strategy dominated leuprolide as it provided patients with more quality-adjusted life years (0.177 versus 0.165) at a lower cost ($1,273 versus $1,366). Across a range of sensitivity analyses, the results remained robust except to the dose of the comparator drug. If leuprolide was administered at 11.25 mg, once every 3 months, the expected cost for the leuprolide strategy would decline and the associated incremental cost-utility ratio for ulipristal would be $168/quality-adjusted life year.ConclusionUlipristal offers a unique opportunity to effectively and rapidly control menstrual bleeding in patients with uterine fibroids; thereby improving their quality of life while minimizing the probability of moderate-to-severe hot flashes that are common with leuprolide. The current economic analysis suggests that ulipristal remains the dominant strategy across extensive sensitivity analyses.

Ulipristal acetate for pre-operative treatment of moderate-to-severe uterine fibroids in women of reproductive age in The Netherlands: cost minimization analysis and budget impact analysis

“…The most recent economic evaluation study in this field was a cost-utility analysis to assess ulipristal acetate for the care of symptomatic uterine fibroids in comparison with leuprolide, in Canada. In this study, the model suggested that ulipristal acetate strategy dominated leuprolide over the range of alternative settings as it is provided to Canadian patients, with more quality-adjusted life years (QALYs) at a lower cost from both a healthcare payer and a societal perspective 23 . As the use of ulipristal acetate has been authorized by the manufacturer worldwide, we can expect more research to firmly establish the contribution of ulipristal acetate in the management of uterine fibroids patients 24 .…”

Selective progesterone receptor modulators for fertility preservation in women with symptomatic uterine fibroids†

“…A Canadian economic study evaluated the cost utility of preoperative UPA administration relative to LA in women with moderate-to-severe symptoms of UFs. It showed an emphasizing domination of UPA strategy over LA, as it provided patients with more quality-adjusted life years (0.177 versus 0.165) at a lower cost ($1273 versus $1366) with fewer side effects and faster bleeding control [ 143 ]. A similar study was conducted in Mexico, concluding that UPA is a cost-effective alternative to surgery, as 21% of the patients treated with UPA avoided hysterectomy, which translates to $47,614,017 USD being saved for every 1000 patients.…”

Reply

“…Their analysis concluded that UPA provided more quality-adjusted life years at a lower cost than leuprolide, because of its faster control of bleeding, lower incidence of hot flashes, and reduced healthcare resource consumption. 5 We agree that further robust analyses will occur only after long-term evaluation; currently, there are several long-term studies ongoing for the SPRM class of medications globally. Beyond clinical trials, a prospective observational noninterventional the Canadian women wiTh Uterine fibroids (UF) REgistry (CAPTURE) of 1500 women with symptomatic fibroid tumors has completed enrollment.…”