Economic impact of Tibolone compared with Continuous-Combined Hormone Replacement Therapy in the management of climacteric symptoms in postmenopausal women.
BACKGROUND
Deciding whether to treat postmenopausal women suffering from climacteric symptoms with Continuous Combined Hormone Replacement Therapy (CCHRT) has become increasingly difficult after the release of the Women's Health Initiative results. As a result, development of alternatives to CCHRT is required. Tibolone, which is a synthetic steroid that has estrogenic, progestogenic and androgenic properties, is reported to be a promising alternative. It has been used in Europe, in the same indication as CCHRT, for approximately 20 years but is not yet available in Canada.


OBJECTIVE
We carried out a cost-utility analysis comparing a 3-year-treatment course with Tibolone 2.5mg and conjugated equine estrogens (CEE)/medroxyprogesterone acetate (MPA) (0.625 mg/2.5 mg) in the management of postmenopausal women with climacteric symptoms.


METHODS
A Markov model, considering persistence, vaginal bleeding and climacteric symptoms, was elaborated to compare the different options in terms of cost and Quality Adjusted Life Years (QALYs), according to a public third-party payer perspective.


RESULTS
Compared with CEE/MPA, Tibolone led to an increase in cost (dollars 485 for Tibolone versus dollars 232 for CEE/MPA) and a slight increase in QALYs (2.08 for Tibolone versus 2.05 for CEE/MPA). Consequently, the incremental cost per QALY gained ratio was dollars 9198.


CONCLUSIONS
According to the results, Tibolone seems to be a cost-effective alternative to CEE/MPA. However, those results should be interpreted with caution insofar as the difference in terms of QALY is clinically difficult to value and taking into account the limited data on Tibolone's long-term innocuity.
Diaby
Vakaramoko
V
Faculty of Pharmacy, University of Montreal, Centre-ville, Montreal, QC H3C 3J7, Canada. vakaramoko.diaby@umontreal.ca
Perreault
Sylvie
S
Lachaine
Jean
J
D002170:Canada; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D020847:Estrogen Receptor Modulators / Q000191:economics* / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy / Q000191:economics*; D004966:Estrogens, Conjugated (USP) / Q000191:economics / Q000627:therapeutic use; D005260:Female; D019584:Hot Flashes / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008390:Markov Chains; D017258:Medroxyprogesterone Acetate / Q000191:economics / Q000627:therapeutic use; D008875:Middle Aged; D009652:Norpregnenes / Q000191:economics* / Q000627:therapeutic use; D017698:Postmenopause; D019057:Quality-Adjusted Life Years
D020847:Estrogen Receptor Modulators; D004966:Estrogens, Conjugated (USP); D009652:Norpregnenes; D017258:Medroxyprogesterone Acetate; C027385:tibolone