Modelling the Cost Effectiveness and Budget Impact of Uterine Botulinum Toxin Injections in Severe Dysmenorrhoea: A France Perspective

Speaker(s)

Kouame KJ1, Guertin J2, Bautrant E3, Leveque C3, Santos M3, Delorme J3, Franke O3, Amiel C3, Bensousan T3, Thier-Bautrant D3, Siani C4
1Aix Marseille Université, Talence, BORDEAUX, France, 2Département de médecine sociale et préventive, Faculté de médecine de l'université Laval, Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada, 34Women’s Health Research Center,, Aix-Provence, France, 4ISPB, Faculte de Pharmacie, Lyon, France, University Lyon 1, University of Lyon, Lyon, France

Presentation Documents

OBJECTIVES: To assess the efficiency and budget impact of the combination of botulinum toxin (BT)+ conventional treatment (CT) (hormonal treatments + analgesics) compared with CT alone, in patients with severe dysmenorrhoea.

METHODS: A Markov model was developed to estimate, from the perspective of the French Health Insurance, the efficiency and the budget impact of BT + CT compared with CT alone. The main health states in the model were defined on the basis of Visual Analogue Scale (VAS) scores. Parameters were derived from a cohort of patients treated for 12 months at the Women Health Research Centre for severe dysmenorrhoea. Direct healthcare costs were taken into account in the Cost-Utility Analysis (CUA) and Budget Impact Analysis (BIA). The main evaluation criteria were the Incremental Cost-Utility Ratio (ICUR) for the CUA and the net impact for the BIA. Deterministic and probabilistic univariate sensitivity analyses were performed to assess the robustness of our results.

RESULTS: Over the 1-year Time Horizon, the costs and QALYs of BT+CT versus CT alone were €1895.65 vs €3055.20 and 2.03 QALYs vs 1.23 QALYs respectively. Consequently, the ICUR equal to -€1651.5 / QALY, shows that, although the initial costs of BT are higher than those of CT, the reduced follow-up costs associated with the long-term efficacy of BT make it the most effective and economically dominant option at 1, 5 and 10 years. Sensitivity analyses show that 100% of Monte Carlo iterations are below the efficiency threshold of €30,000 /QALY, making BT+CT an efficient strategy that could be adopted and reimbursed.

CONCLUSIONS: In the absence of a reference treatment for the management of severe dysmenorrhoea, BT+CT offers a substantial improvement in quality of life of patients, as well as a reduction in follow-up costs. Therefore this treatment seems to be promising since it is the most cost-effective strategy over 10 years.

Code

EE707

Topic

Economic Evaluation

Topic Subcategory

Budget Impact Analysis, Cost-comparison, Effectiveness, Utility, Benefit Analysis, Value of Information

Disease

Drugs, Reproductive & Sexual Health