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Cost-Effectiveness Analysis of Treatments for Premenstrual Dysphoric Disorder

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Author Info

  • Regina Rendas-Baum

    (QualityMetric Incorporated, Lincoln, Rhode Island, USA)

  • Min Yang

    (QualityMetric Incorporated, Lincoln, Rhode Island, USA)

  • Joseph Gricar

    (Independent Health Care Consultant, New York, New York, USA)

  • Gene V. Wallenstein

    (Pfizer Incorporated, New London, Connecticut, USA)

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    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. Abstract: 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). Abstract: 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. Abstract: 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 $US4385 per treatment success (year 2007 values). Cost-effectiveness acceptability curves revealed that for ceiling ratios ≥$US3450 per treatment success, fluoxetine had the highest probability (≥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 ≤$US3900 per treatment success. Abstract: Conclusion: These analyses suggest that initiating therapy with DRSP/EE may be a cost-effective option in the treatment of PMDD.

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    Bibliographic Info

    Article provided by Springer Healthcare | Adis in its journal Applied Health Economics and Health Policy.

    Volume (Year): 8 (2010)
    Issue (Month): 2 ()
    Pages: 129-140
    Download reference. The following formats are available: HTML (with abstract), plain text (with abstract), BibTeX, RIS (EndNote, RefMan, ProCite), ReDIF
    Handle: RePEc:wkh:aheahp:v:8:y:2010:i:2:p:129-140

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    Web page: http://healtheconomics.adisonline.com/

    For corrections or technical questions regarding this item, or to correct its listing, contact: (Dave Dustin).

    Related research

    Keywords: Cost-effectiveness; Ethinylestradiol/drospirenone; therapeutic use; Fluoxetine; therapeutic use; Paroxetine; therapeutic use; Premenstrual-dysphoric-disorder; treatment; Sertraline; therapeutic use;

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