The cost-effectiveness of oral contraceptives compared to ‘no hormonal treatment’ for endometriosis-related pain: An economic evaluation

Abstract

ObjectiveTo develop a preliminary cost-effectiveness model that compares oral contraceptives and ‘no hormonal treatment’ for the treatment of endometriosis-related pain.MethodsA de novo preliminary state transition (Markov) model was developed. The model was informed by systematic literature review and expert opinion. The uncertainty around the results was assessed both by deterministic and probabilistic sensitivity analyses. The economic evaluation was conducted from National Health Service (NHS) England perspective. The main outcome measure was incremental cost per quality-adjusted life year (QALY), with cost-effectiveness plane and cost-effectiveness acceptability curves presented for alternative willingness-to-pay thresholds.ResultsOral contraceptives dominated ‘no hormonal treatment’ and provided more QALYs at a lower cost than ‘no hormonal treatment’, with a cost-effectiveness probability of 98%. A one-way sensitivity analysis excluding general practitioner consultations showed that oral contraceptives were still cost-effective.ConclusionsThe analyses showed that oral contraceptives could be an effective option for the treatment of endometriosis, as this treatment was shown to provide a higher level of QALYs at a lower cost, compared to ‘no hormonal treatment’. The results are subject to considerable parameter uncertainty as a range of assumptions were required as part of the modelling process.

The Use of Expert Elicitation among Computational Modeling Studies in Health Research: A Systematic Review

“…The most frequent methods were Delphi or modified Delphi process ( n = 10), 13,36,37,41,42,47,55,58,61,66 while 2 used the SHELF method 63,64 ; both methods rely on multiple rounds of discussion to build consensus among experts. Elicitations were frequently done virtually or over the phone ( n = 13) 14,36,41,46,48,50,53,55,57,66,67,70,71 while only 5 specified that the elicitation was conducted in person. 38,39,48,51,60 Web- or spreadsheet-based elicitation tools were used to facilitate data collection in 9 elicitations.…”

“…38,39,48,51,60 Web- or spreadsheet-based elicitation tools were used to facilitate data collection in 9 elicitations. 12,40,48,50,51,62,64,65,68…”

A Rare Case of Endometriosis of the Small Bowel

“…From infertility issues to unmanageable pain, endo.metriosis causes untold morbidity, including economic and social distress, for women and their families [6][7][8][9]. That is why it is paramount to have a high index of suspicion when reproductive age women present to their healthcare pro-viders with vague signs and symptoms of abdominal pain [10,11].…”

O Uso De Anticoncepcionais Orais Combinados Na Melhoria Da Qualidade De Vida De Adolescentes Com Endometriose

“…Este ponto será melhor analisado a seguir (21,22,7) . A endometriose é uma afecção ginecológica benigna, imuno e estrogênio dependente, crônica, qualificada pela proliferação e desenvolvimento de estroma (tipo de tecido conjuntivo vascularizado que compõe o tecido nutritivo e estrutural de um órgão) e de glândulas endometriais externamente à cavidade uterina, o que desencadeia um processo inflamatório, acarretando a formação de cicatrizes e aderências que podem causar algia extenuante, períodos menstruais acentuados e tendo como consequência provável, a infertilidade, caso os focos endometriais estejam alocados próximos aos ovários, pois possibilitam o comprometimento da anatomia pélvica (1,2,24,25,5,6,7,8) .…”

“…Portanto, há evidências que corroboram que o uso de ACOs é tão útil no alívio dos sintomas da endometriose, tal qual a maioria dos outros medicamentos utilizados, ainda mais quando seu consumo se dá de forma contínua. Não obstante, seu uso no público adolescente traz grandes vantagens porque além de apresentar uma alta efetividade no combate ao quadro sintomático da doença, possui pouquíssimos efeitos adversos quando se comparado aos anti-inflamatórios não esteroides, que também são um recurso terapêutico e não prejudica no desenvolvimento de tecido ósseo como no caso do GnRH, além de atuar também, como um redutor das taxas de gravidez na adolescência (58,8,29) .…”