Cost-effectiveness analysis of treatments for premenstrual dysphoric disorder

被引：9

作者：

Rendas-Baum R. ^{[1
]}

Yang M. ^{[1
]}

Gricar J. ^{[2
]}

Wallenstein G.V. ^{[3
]}

机构：

[1] Outcomes Insight Consulting, QualityMetric Incorporated, Lincoln, RI 02865

[2] Independent Health Care Consultant, New York, NY

[3] Pfizer Incorporated, New London, CT

来源：

Applied Health Economics and Health Policy | 2010年 / 8卷 / 2期

关键词：

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

D O I：

10.2165/11532210-000000000-00000

中图分类号：

学科分类号：

摘要：

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. 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). 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 costeffectiveness 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. 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. Conclusion: These analyses suggest that initiating therapy with DRSP/EE may be a cost-effective option in the treatment of PMDD. © 2010 Adis Data Information BV.

引用

页码：129 / 140

页数：11

共 54 条

[1]

Gehlert S., Hartlage S., A design for studying the DSM-IV research criteria of premenstrual dysphoric disorder, J Psychosom Obstet Gynaecol, 18, 1, pp. 36-442, (1997)

[2]

Hylan T.R., Sundell K., Judge R., The impact of premenstrual symptomatology on functioning and treatment-seeking behavior: Experience from the United States, United Kingdom, and France, J Womens Health Gend Based Med, 8, 8, pp. 1043-1052, (1999)

[3]

Angst J., Sellaro R., Merikangas K.R., Et al., The epidemiology of perimenstrual psychological symptoms, Acta Psychiatr Scand, 104, 2, pp. 110-116, (2001)

[4]

Wittchen H.U., Becker E., Lieb R., Et al., Prevalence, incidence and stability of premenstrual dysphoric disorder in the community, Psychol Med, 32, 1, pp. 119-132, (2002)

[5]

Sternfeld B., Swindle R., Chawla A., Et al., Severity of premenstrual symptoms in a health maintenance organization population, Obstet Gynecol, 99, 6, pp. 1014-1024, (2002)

[6]

Halbreich U., Borenstein J., Pearlstein T., Et al., The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD), Psychoneuroendocrinology, 28, SUPPL. 3, pp. 1-23, (2003)

[7]

Diagnostic and Statistical Manual of Mental Disorders, pp. 771-774, (2000)

[8]

Freeman E.W., Jabara S., Sondheimer S.J., Et al., Citalopram in PMS patients with prior SSRI treatment failure: A preliminary study, J Womens Health Gend Based Med, 11, 5, pp. 459-464, (2002)

[9]

Dimmock P.W., Wyatt K.M., Jones P.W., Et al., Efficacy of selective serotonin-reuptake inhibitors in premenstrual syndrome: A systematic review, Lancet, 356, 9236, pp. 1131-1136, (2000)

[10]

Croghan T.W., Tomlin M., Pescosolido B.A., Et al., American attitudes toward and willingness to use psychiatric medications, J Nerv Ment Dis, 191, 3, pp. 166-174, (2003)

← 1 2 3 4 5 6 →