Cost-Effectiveness of Linzagolix for Uterine Fibroids in Australia: A Healthcare Payer and Societal Perspective

OBJECTIVES: To evaluate the cost-effectiveness of linzagolix plus best supportive care (BSC) compared to BSC alone for the treatment of moderate to severe symptoms of uterine fibroids (UFs), including heavy menstrual bleeding (HMB), in premenopausal adult women in Australia from a healthcare payer and societal perspective. Due to the lack of reimbursed treatment options, there is a high clinical need.

METHODS: A combined decision tree and Markov model with monthly cycles was used to estimate costs and health outcomes from treatment initiation to menopause when symptoms naturally resolve. The structure of the model accounts for varying female age at treatment initiation and menopause, resulting in a variable time horizon of 3-21 years. Transition probabilities and utility weights were obtained from the PRIMROSE trials and literature. Direct cost inputs included costs for linzagolix treatment, bone mineral density monitoring, and hospitalizations. These costs were obtained based on Medicare Benefits Schedule and Pharmaceutical Benefits Scheme item fees as well as AR-DRGs. Productivity costs were informed by literature.

RESULTS: Linzagolix treatment is associated with a 0.1741 QALY gain and additional costs of $8,232 compared to BSC, resulting in an incremental cost-effectiveness ratio (ICER) of $47,274/QALY gained from a healthcare payer perspective. Due to the significant productivity costs associated with UFs, a societal perspective suggests an ICER as low as $4,865/QALY gained. Sensitivity analyses suggest that results are sensitive to the probability of progressing to surgery and the utility gain from achieving remission.

CONCLUSIONS: There is an urgent clinical need for reimbursed treatments for moderate to severe symptoms of UFs, which include HMB and can severely impact women’s quality of life (QoL), mental health, and daily activities. This analysis indicates that linzagolix provides a meaningful QoL improvement at a reliably estimated and reasonable level of cost-effectiveness – even more so when a societal perspective is considered.