Medical therapy for preventing recurrent endometriosis after conservative surgery: a cost-effectiveness analysis

BJOG. 2018 Mar;125(4):469-477. doi: 10.1111/1471-0528.14786. Epub 2017 Jul 26.


Objective: To assess the cost-effectiveness of different strategies, including gonadotropin-releasing hormone agonist (GnRH-a) and oral contraceptive therapy, for the prevention of endometriosis recurrence after conservative surgery.

Design: Cost-effectiveness analysis from a health care perspective.

Setting: A health-resource-limited setting in China.

Population: Patients who underwent conservative laparoscopic or laparotomic surgery for endometriosis.

Methods: A Markov model was developed for the endometriosis disease course. Clinical data were obtained from published studies. Direct medical costs and resource utilization in the Chinese health care setting were taken into account. The health and economic outcomes were evaluated over a period from treatment initiation to menopause onset. Sensitivity analyses were carried out to test the impact of various parameters and assumptions on the model output.

Main outcome measures: Quality-adjusted life years (QALYs) gained and costs from a health care perspective.

Results: The incremental cost-effectiveness ratio of 6-month GnRH-a therapy compared with no therapy ranged from $6,185 per QALY in deep endometriosis to $6,425 with peritoneal endometriosis. A one-way sensitivity analysis showed considerable influential factors, such as remission rates and utility values. Probabilistic sensitivity analysis indicated that 6-month GnRH-a therapy is cost-effective in most cases at a threshold of $7,400/QALY, regardless of the type of endometriosis.

Conclusion: Six months of therapy with GnRH-a can be a highly cost-effective option for the prevention of endometriosis recurrence.

Tweetable abstract: Gonadotropin-releasing hormone agonist is cost effective for the prevention of endometriosis recurrence.

Keywords: Cost-effectiveness; endometriosis; gonadotropin-releasing hormone agonist; recurrence.

MeSH terms

  • China / epidemiology
  • Contraceptive Agents, Female* / economics
  • Contraceptive Agents, Female* / therapeutic use
  • Cost-Benefit Analysis* / methods
  • Cost-Benefit Analysis* / statistics & numerical data
  • Endometriosis* / economics
  • Endometriosis* / epidemiology
  • Endometriosis* / therapy
  • Female
  • Gonadotropin-Releasing Hormone / agonists*
  • Health Care Rationing
  • Humans
  • Laparoscopy / adverse effects
  • Laparoscopy / methods
  • Laparotomy / adverse effects
  • Laparotomy / methods
  • Markov Chains
  • Outcome Assessment, Health Care
  • Quality-Adjusted Life Years
  • Recurrence
  • Secondary Prevention* / economics
  • Secondary Prevention* / methods
  • Socioeconomic Factors


  • Contraceptive Agents, Female
  • Gonadotropin-Releasing Hormone