Cost-Utility Analysis of Linzagolix 200 mg Plus Add-back Therapy (Linzagolix+ABT) for Symptomatic Treatment of Endometriosis
Author(s)
Grzegorz Binowski, MA1, Anna Packowska, BA1, Anne Marciniak, MD, PhD, MBA, MPhil, Msc2, Rowena Cottrell, PhD2, Simone Currell, BSc2, Alison Lawrence, MSc, BPharm(Hons)3, Lance Richard, MPharm, MPS, PgDip(HealthEcon), MSc3, James Grainger, MSc, BSc3.
1MAHTA Intl., Warsaw, Poland, 2Theramex, London, United Kingdom, 3Decisive Consulting, London, United Kingdom.
1MAHTA Intl., Warsaw, Poland, 2Theramex, London, United Kingdom, 3Decisive Consulting, London, United Kingdom.
OBJECTIVES: Endometriosis is a chronic disease affecting 10% of women worldwide. It causes chronic pelvic pain and dysmenorrhoea, significantly impairing health‐related quality of life (HRQoL) and causing substantial humanistic and economic burden. First‐line therapies typically involve combined oral contraceptives or progestins. Existing second‐line medical treatments include injectable gonadotropin-releasing hormone (GnRH) agonists, which are unsuitable for long‐term use due to safety concerns (e.g. osteoporosis), highlighting the unmet need for tolerable and effective alternative medical treatments suitable for long-term use. Linzagolix, an oral GnRH antagonist +ABT shows promise by effectively reducing endometriosis-associated pain and improving HRQoL, while minimizing loss of bone mineral density. The objective of the analysis was to assess the cost‐effectiveness of linzagolix+ABT versus GnRH agonists for women with endometriosis who did not effectively respond to first-line medical treatments.
METHODS: A de novo semi-Markov cohort model was developed to capture the complexities of endometriosis management. It includes 17 health states reflecting initial treatment response and subsequent medical and surgical strategies. The analysis, conducted from the UK NHS perspective, employed a 15-year time horizon to comprehensively capture chronic pelvic disease trajectory up to menopause. Linzagolix was compared against a composite of injectable GnRH agonists (leuprorelin acetate, goserelin, triptorelin). Clinical data were derived from a systematic literature review and indirect treatment comparison. Sensitivity analyses were performed to assess uncertainty around key clinical, HRQoL and cost inputs.
RESULTS: Compared to GnRH agonists, linzagolix+ABT incurred additional costs of £2,252 and generated 0.41 incremental quality-adjusted life-years (QALYs), yielding an incremental cost-effectiveness ratio of £5,554 per QALY, well below the £20,000 NICE threshold. Additionally, linzagolix treatment decreased radical surgery risk by 39%.
CONCLUSIONS: Linzagolix+ABT is cost-effective, enhances HRQoL, and reduces the need for radical surgeries, thereby also helping to preserve fertility. These benefits strongly support the adoption of linzagolix into clinical practice for endometriosis management.
METHODS: A de novo semi-Markov cohort model was developed to capture the complexities of endometriosis management. It includes 17 health states reflecting initial treatment response and subsequent medical and surgical strategies. The analysis, conducted from the UK NHS perspective, employed a 15-year time horizon to comprehensively capture chronic pelvic disease trajectory up to menopause. Linzagolix was compared against a composite of injectable GnRH agonists (leuprorelin acetate, goserelin, triptorelin). Clinical data were derived from a systematic literature review and indirect treatment comparison. Sensitivity analyses were performed to assess uncertainty around key clinical, HRQoL and cost inputs.
RESULTS: Compared to GnRH agonists, linzagolix+ABT incurred additional costs of £2,252 and generated 0.41 incremental quality-adjusted life-years (QALYs), yielding an incremental cost-effectiveness ratio of £5,554 per QALY, well below the £20,000 NICE threshold. Additionally, linzagolix treatment decreased radical surgery risk by 39%.
CONCLUSIONS: Linzagolix+ABT is cost-effective, enhances HRQoL, and reduces the need for radical surgeries, thereby also helping to preserve fertility. These benefits strongly support the adoption of linzagolix into clinical practice for endometriosis management.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE304
Topic
Economic Evaluation
Disease
Reproductive & Sexual Health, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)