title: The cost-effectiveness of ulipristal acetate tablets in treating patients with moderate to severe symptoms of uterine fibroids.
abstract: OBJECTIVE
  Ulipristal acetate is a selective progesterone receptor modulator that has been demonstrated to be an effective 3-month pre-operative treatment for moderate to severe symptoms of uterine fibroids in adult women of reproductive age. The aim of this analysis was to assess the cost-effectiveness of 5mg ulipristal as an add-on therapy to standard pre-surgical observation and treatment in Hungary.
  
  
  METHODS
  A Markov model was developed using a 10-year time horizon. Ulipristal was compared with pre-surgical observation and immediate hysterectomy. The model comprised the following mutually exclusive health states: mild, moderate, severe, or persistent severe excessive bleeding disorder; myomectomy; post-myomectomy with mildly to moderately excessive bleeding disorder; post-myomectomy with severely excessive bleeding disorder; hysterectomy; post-hysterectomy; post-menopause; and death. Transition probabilities and utility values were obtained from clinical trials and the scientific literature. Resource utilisation and unit costs were derived from a consensus panel of clinical experts, National Health Insurance Fund tariffs, and publications.
  
  
  RESULTS
  Adding a 3-month course of ulipristal to pre-operative observation was predicted to achieve an additional 0.021 quality-adjusted life years (QALYs) at an estimated incremental cost of €397, which would result in an incremental cost of €19,200/QALY. When 3 months of ulipristal therapy was compared with immediate hysterectomy, the incremental cost-effectiveness ratio was reduced to €3575/QALY. The results were most sensitive to the utility value of the post-hysterectomy health state but responsive to changes in other model parameters.
  
  
  CONCLUSIONS
  The results of this analysis suggest that adding ulipristal treatment to standard pre-surgical therapy represents a good value for money in Hungary. The inclusion of societal benefits may considerably reduce the cost-effectiveness ratio.
authors.affiliation: Department of Health Policy & Health Economics, Institute of Economics, Faculty of Social Sciences, Eötvös Loránd University, Budapest 1117, Hungary; Syreon Research Institute, Budapest 1146, Hungary.
authors.forename: Balázs
authors.initials: B
authors.lastname: Nagy
authors.affiliation: Syreon Research Institute, Budapest 1146, Hungary.
authors.forename: György
authors.initials: G
authors.lastname: Timár
authors.affiliation: Syreon Research Institute, Budapest 1146, Hungary.
authors.forename: Judit
authors.initials: J
authors.lastname: Józwiak-Hagymásy
authors.affiliation: Syreon Research Institute, Budapest 1146, Hungary.
authors.forename: Gábor
authors.initials: G
authors.lastname: Kovács
authors.affiliation: Syreon Research Institute, Budapest 1146, Hungary.
authors.forename: Gergő
authors.initials: G
authors.lastname: Merész
authors.affiliation: Gedeon Richter Plc., Budapest 1103, Hungary.
authors.forename: István
authors.initials: I
authors.lastname: Vámossy
authors.affiliation: Gedeon Richter Plc., Budapest 1103, Hungary.
authors.forename: Tamás
authors.initials: T
authors.lastname: Ágh
authors.affiliation: Bajcsy-Zsilinszky Hospital, Budapest 1106, Hungary.
authors.forename: Ádám
authors.initials: Á
authors.lastname: László
authors.affiliation: Department of Health Policy & Health Economics, Institute of Economics, Faculty of Social Sciences, Eötvös Loránd University, Budapest 1117, Hungary; Syreon Research Institute, Budapest 1146, Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Vokó
authors.affiliation: Department of Health Policy & Health Economics, Institute of Economics, Faculty of Social Sciences, Eötvös Loránd University, Budapest 1117, Hungary; Syreon Research Institute, Budapest 1146, Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Kaló
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000188:drug therapy* / Q000191:economics / Q000601:surgery; D018803:Models, Economic; D009649:Norpregnadienes / Q000191:economics / Q000627:therapeutic use*; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000601:surgery
chemical_list: D009649:Norpregnadienes; C555622:ulipristal acetate
keywords: Cost-effectiveness; Cost-utility analysis; Economic evaluation; Ulipristal acetate