Elagolix Versus Laparoscopic Surgery for Treatment of Pain Due to Endometriosis: A Cost-Effectiveness Analysis [12J]

INTRODUCTION: The objective was to assess the cost-effectiveness Elagolix versus laparoscopic conservative surgery as the primary treatment of moderate to severe pain due to endometriosis. METHODS: A Markov model was developed comparing primary treatment with Elagolix to primary laparoscopic conservative surgery for patients with moderate to severe pain due to endometriosis. Clinical and surgical data were obtained from published literature. Medical costs were obtained utilizing contemporary charges for standard treatments. The medical and financial outcomes were evaluated from time of patient presentation with moderate to severe pain, until time of patient death. A sensitivity analysis was performed to evaluate the significance of various medical and financial parameters designated within the model on disease specific outcomes. Main outcome was measured in quality-adjusted life years (QALYs) and costs from a national healthcare perspective. RESULTS: Laparoscopic conservative surgery was a strongly dominant treatment strategy when compared to Elagolix for the purpose of primary treatment for moderate to severe pain from endometriosis based on our Monte-Carlo microsimulation cost-effectiveness analysis. A second order probabilistic sensitivity analysis demonstrated that laparoscopic conservative surgery for endometriosis is cost-effective when compared to Elagolix for primary treatment of moderate to severe pain from endometriosis, with a willingness to pay threshold of $410.35 per QALY over all ranges of varying utilities and costs utilized. CONCLUSION: From a national healthcare perspective, laparoscopic conservative surgery for endometriosis is more cost-effective than Elagolix for the primary treatment of moderate to severe pain from endometriosis that has been refractory to standard medical care.