Cost effectiveness analysis of goserelin empiric therapy for treatment of deep endometriosis

Abstract

PURPOSE: To perform a comparative cost-effectiveness analysis from the Brazilian Public Health System’s perspective of the standard treatment with goserelin acetate of only patients with deep endometriosis confirmed by videolaparoscopy versus empirical treatment with goserelin acetate of all patients with chronic pelvic pain and suspected deep endometriosis. METHODS: To determine the local experience of standard treatment and empiric treatment, it was conducted a specialist consult with a gynecologist from a public institution, with large experience in endometriosis treatment. It was developed an analytic decision model to estimate the cost effectiveness ratio of empiric treatment versus standard treatment with goserelin depot 3,6 mg every 4 weeks, during 6 months. Efficacy rates were obtained from published literature. The model includes only direct costs, obtained from Ambulatory and Hospital Information System and Price Database of Brazilian Ministry of Health. The outcome used was time until symptoms improvement. RESULTS: The costeffectiveness analysis revealed that the empiric therapy with goserelin leads to a reduction of time until improvement of symptoms of 3 months, and lower cost (R$ 2,731 reduction, equivalent to $ 1,645), when compared to the standard treatment with previous videolaparoscopy. CONCLUSIONS: Empiric therapy of deep endometriosis using goserelin acetate seems to be a cost-saving alternative in the Brazilian Unified Health System scenario.