The cost-effectiveness of ulipristal acetate tablets in treating patients with moderate to severe symptoms of uterine fibroids

Nagy, Balázs; Tímár, G.; Józwiak-Hagymásy, Judit; Kovàcs, Gabór; Merész, Gergő; Vámossy, I.; Ágh, Tamás; László, Ádám; Vokó, Zoltán; Kaló, Zoltán

doi:10.1016/j.ejogrb.2014.01.022

Cited by 13 publications

(10 citation statements)

References 13 publications

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“…Pharmacoeconomic and outcome research studies were, and still being, conducted to study the cost-effectiveness of UPA as either an add-on or alternative therapy option to surgery, with positive results showing a favorable cost-effectiveness ratio [ 142 ]. A Canadian economic study evaluated the cost utility of preoperative UPA administration relative to LA in women with moderate-to-severe symptoms of UFs.…”

Section: Treatment Options For Uterine Fibroidsmentioning

confidence: 99%

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

Ali

Al-Hendy

2017

Biology of Reproduction

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Uterine fibroids (UFs, AKA leiomyoma) are the most important benign neoplastic threat to women's health, with costs up to hundreds of billions of health care dollars worldwide. Uterine fibroids caused morbidities exert a tremendous health toll, impacting the quality of life of women of all ethnicities, especially women of color. Clinical presentations include heavy vaginal bleeding, pelvic pain, bulk symptoms, subfertility, and obstetric complications. Current management strategies heavily lean toward surgical procedures; nonetheless, the choice of treatment is generally subject to patient's age and her desire to preserve future fertility. Women with UF who desire to maintain future fertility potential face a dilemma because of the limited treatment choices that are currently available to help them achieve that goal. Recently, ulipristal acetate the first of the promising family of oral selective progesterone receptor modulators has been approved for UF treatment in Europe, Canada, and several other countries and is under review for possible approval in the USA. In this review article, we discuss recent advances in the management options against UF with a bend toward oral effective long-term treatment alternatives who are particularly suited for those seeking to preserve their future fertility potential. We also explore the transformative concept of primary and secondary UF prevention using these new anti-UF agents. We envision a remarkable shift in the management of UF in future years from surgical/invasive treatment to orally administrated options; clearly, this potential shift will require additional intense clinical research.

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Section: Treatment Options For Uterine Fibroidsmentioning

confidence: 99%

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

Ali

Al-Hendy

2017

Biology of Reproduction

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“…However, UFs with mild symptoms could be managed with drugs aimed to attend to the specific symptom, usually bleeding or pain. 60 – 62 , 65 – 67 , 73 …”

Section: Discussionmentioning

confidence: 99%

Updated approaches for management of uterine fibroids

Mas¹,

Tarazona²,

Carrasco³

et al. 2017

IJWH

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Uterine anatomy and uterine fibroids (UFs) characteristics have been classically considered as almost a unique issue in gynecology and reproductive medicine. Nowadays, the management of UF pathology is undergoing an important evolution, with the patient’s quality of life being the most important aspect to consider. Accordingly, surgical techniques and aggressive treatments are reserved for only those cases with heavy symptomatology, while the clinical diagnostic based on size and number of UFs remains in a second plane in these situations. Moreover, the development of several noninvasive surgical techniques, especially the appearance of ulipristal acetate as a medical etiological treatment, has substantially changed the clinical indications. As a consequence, after almost 2 decades without relevant updates, it has been necessary to update the protocols for the management of UFs in the Spanish Society of Gynecology and Obstetrics twice. Accordingly, we believe that it is necessary to translate our experience to protocolize the medical care for patients with UFs, incorporating these new therapeutic options, and selecting the best treatment for them. We highlight the importance of achieving the patient’s goals and decisions by improving the clinical diagnosis for these type of pathologies, allowing enhanced personalized treatments, as well as the reduction of potential risks and unnecessary surgeries.

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“…Recently, an economic evaluation has been published on ulipristal from a Hungarian perspective. 34 In determining whether those results can be generalized to other settings, such as Canada, one must consider the International Society for Pharmacoeconomics and Outcomes Research guidelines on the transferability of health economic models across jurisdictions. 35 In these guidelines, models are suggested to be transferable unless significant variations exist either in the disease progression or in the clinical practice between jurisdictions.…”

Section: Discussionmentioning

confidence: 99%

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

Tsoi¹,

Blackhouse²,

Ferrazzi³

et al. 2015

CEOR

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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.

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The cost-effectiveness of ulipristal acetate tablets in treating patients with moderate to severe symptoms of uterine fibroids

Cited by 13 publications

References 13 publications

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

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

Updated approaches for management of uterine fibroids

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

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