title: Cost-effectiveness analysis of treatments for premenstrual dysphoric disorder.
abstract: BACKGROUND
  Premenstrual syndrome (PMS) is reported to affect between 13% and 31% of women. Between 3% and 8% of women are reported to meet criteria for the more severe form of PMS, premenstrual dysphoric disorder (PMDD). Although PMDD has received increased attention in recent years, the cost effectiveness of treatments for PMDD remains unknown.
  
  
  OBJECTIVE
  To evaluate the cost effectiveness of the four medications with a US FDA-approved indication for PMDD: fluoxetine, sertraline, paroxetine and drospirenone plus ethinyl estradiol (DRSP/EE).
  
  
  METHODS
  A decision-analytic model was used to evaluate both direct costs (medication and physician visits) and clinical outcomes (treatment success, failure and discontinuation). Medication costs were based on average wholesale prices of branded products; physician visit costs were obtained from a claims database study of PMDD patients and the Agency for Healthcare Research and Quality. Clinical outcome probabilities were derived from published clinical trials in PMDD. The incremental cost-effectiveness ratio (ICER) was calculated using the difference in costs and percentage of successfully treated patients at 6 months. Deterministic and probabilistic sensitivity analyses were used to assess the impact of uncertainty in parameter estimates. Threshold values where a change in the cost-effective strategy occurred were identified using a net benefit framework.
  
  
  RESULTS
  Starting therapy with DRSP/EE dominated both sertraline and paroxetine, but not fluoxetine. The estimated ICER of initiating treatment with fluoxetine relative to DRSP/EE was $US4385 per treatment success (year 2007 values). Cost-effectiveness acceptability curves revealed that for ceiling ratios>or=$US3450 per treatment success, fluoxetine had the highest probability (>or=0.37) of being the most cost-effective treatment, relative to the other options. The cost-effectiveness acceptability frontier further indicated that DRSP/EE remained the option with the highest expected net monetary benefit for ceiling values <or=$US3900 per treatment success.
  
  
  CONCLUSIONS
  These analyses suggest that initiating therapy with DRSP/EE may be a cost-effective option in the treatment of PMDD.
authors.affiliation: QualityMetric Incorporated, Lincoln, Rhode Island 02865, USA. rrbaum@qualitymetric.com
authors.forename: Regina
authors.initials: R
authors.lastname: Rendas-Baum
authors.forename: Min
authors.initials: M
authors.lastname: Yang
authors.forename: Joseph
authors.initials: J
authors.lastname: Gricar
authors.forename: Gene V
authors.initials: GV
authors.lastname: Wallenstein
mesh_terms: D000736:Androstenes / Q000191:economics / Q000627:therapeutic use; D017281:Cost of Illness; D003362:Cost-Benefit Analysis / Q000191:economics / Q000706:statistics & numerical data; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D005473:Fluoxetine / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000191:economics / Q000627:therapeutic use; D018803:Models, Economic; D017374:Paroxetine / Q000191:economics / Q000627:therapeutic use; D011293:Premenstrual Syndrome / Q000188:drug therapy / Q000191:economics*; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics / Q000627:therapeutic use; D020280:Sertraline / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000736:Androstenes; D005473:Fluoxetine; D000451:Mineralocorticoid Receptor Antagonists; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline; C035144:drospirenone