OBJECTIVES: We compare the cost-utility of the novel treatment Relugolix/Estradiol/Norethisterone with the current treatment Tranexamic Acid (TXA) for premenopausal women (aged 20-40) with small uterine fibroids (less than 3 cm diameter) from the United Kingdom National Health Service (NHS) perspective.

METHODS: This cost-utility analysis employs decision tree modelling, comparing Relugolix/Estradiol/Norethisterone (intervention arm) with Tranexamic Acid (comparator arm) over a one-year time horizon. Myomectomy is assumed if either treatment is unresponsive after 6 month initial treatment period. Probabilities and utilities are derived from published studies and grey literature. Costs are based on the NHS Tariff Workbook and Unit Cost of Health and Social Care report, adjusted for inflation. Quality-adjusted life years (QALYs) serve as the primary outcome measure, with incremental cost-effectiveness ratio (ICER), net monetary benefit (NMB), and net health benefit (NHB) as secondary outcomes. Univariate sensitivity analysis assesses model robustness.

RESULTS: Base case analysis showed that Relugolix/Estradiol/Norethisterone dominates TXA, yielding lower average cost (£2,110.58 vs £2,292.38) and higher QALYs (0.77 vs 0.74). The ICER is -£6,904.92/QALY, lower than the NHS threshold of £20,000/QALY. Sensitivity analyses indicate the ICER is more sensitive to the change in drug price, and the change of TXA utility had less influence on the outcomes. Moreover, increased Relugolix/Estradiol/Norethisterone and TXA utilities resulted in the ICER reduction.

CONCLUSIONS: Relugolix/Estradiol/Norethisterone could be considered the first-line uterine-preserving treatment for uterine fibroids less than 3 cm in size for women aged 20 to 40 years old. More cost-effectiveness studies regarding this drug needs to be performed, with different comparators and models.