Cost-effectiveness of long-acting progestogens versus the combined oral contraceptives pill for preventing recurrence of endometriosis-related pain following surgery: an economic evaluation alongside the PRE-EMPT trial

Melyda, Melyda; Monahan, Mark; Cooper, Kevin G; Bhattacharya, Siladitya; Daniels, Jane P; Cheed, Versha; Middleton, Lee; Roberts, Tracy E

Abstract

Objectives

To evaluate the cost-effectiveness of long-acting progestogens (LAP), including levonorgestrel-releasing intrauterine system (LNG-IUS) and depot-medroxyprogesterone acetate (DMPA), compared with the combined oral contraceptives pill (COCP) in preventing recurrence of endometriosis-related pain postsurgery.

Design

Within-trial economic evaluation alongside a multicentre, pragmatic, parallel-group, open-label, randomised controlled trial (Preventing Recurrence of Endometriosis by means of Long-Acting Progestogen Therapy trial).

Setting

Thirty-four UK hospitals recruiting participants from November 2015 to March 2019.

Patients

Four hundred and five women aged 16–45 years undergoing conservative endometriosis surgery.

Interventions

The ratio of 1:1 randomisation to receive LAPs (LNG-IUS or DMPA) or COCP.

Main outcome measures

The primary evaluation was a cost-utility analysis based on cost per quality-adjusted life-year (QALY) gained at 3 years. We adopted a UK National Health Service perspective. Secondary analyses in the form of cost-effectiveness analysis based on a range of outcomes were also undertaken.

Results

For the primary analysis, the COCP group incurred an additional cost of £533 (95% CI £52 to £983) per woman compared with LAPs. Treatment with COCP generated additional QALYs of 0.031 (95% CI −0.079 to 0.139) compared with the LAP group over 36-month follow-up. The incremental cost-effectiveness ratio for COCP compared with LAPs is therefore approximately £17 193 per QALY. The probabilistic sensitivity analysis suggested that there was a 54.7% probability that COCP would be cost-effective at the £20 000/QALY threshold. The secondary analyses revealed results more in favour of LAPs.

Conclusion

Although the COCP has a slightly higher probability of being cost-effective at £20 000/QALY threshold, there remains considerable uncertainty, with only marginal differences in outcomes between the two treatments. The lower rates of further surgery and second-line medical treatment for women allocated to LAPs may make this option preferable for some women.

Trial registration number ISRCTN 97865475.

Citation

Melyda, M., Monahan, M., Cooper, K. G., Bhattacharya, S., Daniels, J. P., Cheed, V., Middleton, L., & Roberts, T. E. (2024). Cost-effectiveness of long-acting progestogens versus the combined oral contraceptives pill for preventing recurrence of endometriosis-related pain following surgery: an economic evaluation alongside the PRE-EMPT trial. BMJ Open, 14(12), Article e088072. https://doi.org/10.1136/bmjopen-2024-088072

• Journal Article Type: Article
• Acceptance Date: Nov 11, 2024
• Online Publication Date: Dec 9, 2024
• Publication Date: 2024-12
• Deposit Date: Apr 29, 2025
• Publicly Available Date: Apr 30, 2025
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 14
• Issue: 12
• Article Number: e088072
• DOI: https://doi.org/10.1136/bmjopen-2024-088072
• Public URL: https://nottingham-repository.worktribe.com/output/44986295
• Publisher URL: https://bmjopen.bmj.com/content/14/12/e088072