Post-Surgery Hormonal Treatment in Endometriosis May Not Be Cost-Effective or Beneficial, Analysis Suggests

Post-Surgery Hormonal Treatment in Endometriosis May Not Be Cost-Effective or Beneficial, Analysis Suggests

A cost-benefit analysis of hormone treatments, used to prevent a recurrence of endometriosis after surgery, has found that no treatment at all is the best approach — both for its cost-effectiveness and beneficial outcomes. But the analysis had flaws that add uncertainty to its findings, the research team acknowledged, recommending future and more robust analyses.

The risk of disease recurrence is high after surgical removal of endometriotic tissue, estimated to be around 40–45 percent. A number of small trials have suggested that hormone therapy after surgery might delay or even prevent recurrence.

University of Birmingham researchers partnered with other U.K. institutions to compare the use of various hormonal treatments to no treatment at all, exploring differences in quality of life and health economics. Investigated treatments included the levonorgestrel-releasing intrauterine system, depot-medroxyprogesterone acetate, and combined oral contraceptive pills (COCP), which, along with no pharmaceutical treatment, are the most frequently used approaches in managing endometriosis recurrence after surgery.

The study, Pharmaceutical treatments to prevent recurrence of endometriosis following surgery: a model-based economic evaluation, was a preliminary part of a larger study, which also included a randomized controlled trial.

Researchers used a state-transition model — a computer-based decision-analytic approach taking into account previously published studies. The evaluation took the form of a cost-utility analysis, with the team calculating the cost per quality-adjusted life year (QALY), a measure of disease burden that includes both quality of life and the time lived with a disease.

The cost analysis took into account both the cost of the intervention itself and that of the healthcare staff.

Findings, presented in the journal BMJ Open, showed that over a 36-month period all treatments were more expensive and generated fewer QALYs than no treatment. The levonorgestrel-releasing intrauterine system was the  most expensive and produced the least QALYs, while both depot-medroxyprogesterone acetate and COCP ended up in the mid-range for both cost and outcomes.

The analysis, however, was hampered by a number of uncertainty factors, the researchers acknowledged — issues that might have affected results in unknown ways, and that were not reported in a satisfying manner or not included in the model. The uncertainty factors the team deemed most important were effectiveness of hormonal treatment, treatment changes, and the time of treatment change.

They concluded: “The study highlights the importance of developing decision models at the outset of a trial to identify data requirements to conduct a robust post-trial analysis.”