OBJECTIVES: The main goal of this study was to conduct a cost-effectiveness analysis of vaginal tablet formulation of Prasterone and Estradiol hemihydrate to determine if Prasterone is a cost-effective treatment for moderate to severe dyspareunia associated with menopause.

METHODS: An economic evaluation was performed from the Iranian healthcare perspective by constructing a decision tree model using empirical data (any costs and efficacy) from literature and key opinion leaders over 105 days' time horizons. Model parameters were extracted from randomized controlled trials, and resource use and costs of the drug were drawn from local sources. All costs were presented in 2021 US dollars. Sensitivity analysis was performed based on sensitive parameters described in the tornado diagram.

RESULTS: Prasterone is expected to provoke better quality of life for menopausal women than Estradiol hemihydrate (QALY of 0.224 vs. 0.026 respectively). In addition, the treatment course with Prasterone is doubtlessly cheaper than the estradiol hemihydrate treatment course (7 USD vs. 9.94 USD respectively), which, in consequence, the ICER for Prasterone versus Estradiol hemihydrate was found to be – 15.59 USD. Sensitivity analyses indicated that results were sensitive to estradiol hemihydrate cost.

CONCLUSIONS: Prasterone can be considered a cost-effective vaginal steroid hormone compared with Estradiol hemihydrate in managing moderate to severe dyspareunia patients.