title: Pharmaceutical treatments to prevent recurrence of endometriosis following surgery: a model-based economic evaluation.
abstract: OBJECTIVE
  Conduct an economic evaluation based on best currently available evidence comparing alternative treatments levonorgestrel-releasing intrauterine system, depot-medroxyprogesterone acetate, combined oral contraceptive pill (COCP) and 'no treatment' to prevent recurrence of endometriosis after conservative surgery in primary care, and to inform the design of a planned trial-based economic evaluation.
  
  
  METHODS
  We developed a state transition (Markov) model with a 36-month follow-up. The model structure was informed by a pragmatic review and clinical experts. The economic evaluation adopted a UK National Health Service perspective and was based on an outcome of incremental cost per quality-adjusted life year (QALY). As available data were limited, intentionally wide distributions were assigned around model inputs, and the average costs and outcome of the probabilistic sensitivity analyses were reported.
  
  
  RESULTS
  On average, all strategies were more expensive and generated fewer QALYs compared to no treatment. However, uncertainty attributing to the transition probabilities affected the results. Inputs relating to effectiveness, changes in treatment and the time at which the change is made were the main causes of uncertainty, illustrating areas where robust and specific data collection is required.
  
  
  CONCLUSIONS
  There is currently no evidence to support any treatment being recommended to prevent the recurrence of endometriosis following conservative surgery. The study highlights the importance of developing decision models at the outset of a trial to identify data requirements to conduct a robust post-trial analysis.
authors.affiliation: Health Economics Unit, University of Birmingham, Birmingham, UK School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Sabina
authors.initials: S
authors.lastname: Sanghera
authors.affiliation: Health Economics Unit, University of Birmingham, Birmingham, UK.
authors.forename: Pelham
authors.initials: P
authors.lastname: Barton
authors.affiliation: School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK.
authors.forename: Siladitya
authors.initials: S
authors.lastname: Bhattacharya
authors.affiliation: MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Horne
authors.affiliation: Health Economics Unit, University of Birmingham, Birmingham, UK.
authors.forename: Tracy Elizabeth
authors.initials: TE
authors.lastname: Roberts
mesh_terms: D003271:Contraceptive Agents, Female / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004715:Endometriosis / Q000150:complications / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000627:therapeutic use; D018803:Models, Economic; D011320:Primary Health Care / Q000191:economics; D019057:Quality-Adjusted Life Years; D055502:Secondary Prevention / Q000191:economics; D014148:Tranexamic Acid / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel; D014148:Tranexamic Acid
keywords: OBSTETRICS