Evaluating the cost utility of estradiol plus dydrogesterone for the treatment of menopausal women in China

Figures & data

Figure 1. Structure of the cohort Markov model.

Table 1. Base case model parameters and references.

Parameter	Value	Reference
Cost parameters (average annual cost)
No MHT (menopause with symptoms) = genitourinary syndrome of menopause (C-DRG N95.200) + Depression of menopause (C-DRG F32.801)	¥907 + ¥4,082 = ¥4,990	^31^∼
Breast cancer (C-DRG C50.900)	¥11,649	^31
Endometrial cancer (C-DRG C54.100)	¥17,421	^31
Ovarian cancer (C-DRG C54.100)	¥17,421	^31*
Stroke (C-DRG I63.900)	¥59,748	^31
Coronary heart disease (C-DRG I25.103)	¥5,346	^31
Venous thrombo-embolic events (C-DRG I82.900 × 004)	¥49,492	^31
Fracture of femur (C-DRG S72.900)	¥68,441	^31
Health state utility value parameters
Menopause with symptoms	0.863	^32
Menopause no symptoms	0.956	^32
Breast cancer	0.803	According to ranking, applying 0.06 from menopause with symptoms.
Endometrial cancer	0.803	According to ranking, applying 0.06 from menopause with symptoms.
Ovarian cancer	0.773	According to ranking, applying 0.09 from menopause with symptoms.
Stroke	0.773	According to ranking, applying 0.09 from menopause with symptoms.
Coronary heart disease	0.773	According to ranking, applying 0.09 from menopause with symptoms.
Venous thrombo-embolic events	0.833	According to ranking, applying 0.03 from menopause with symptoms.
Fracture of femur	0.803	According to ranking, applying 0.06 from menopause with symptoms.
Disease risk parameters, relative risk (95% confidence interval)
Breast cancer	0.88 (95% CI 0.76–1.01) for treatment duration 3–4 years; 1.11 (0.94–1.31) for 5–9 years	^33
Endometrial cancer	1.0 (0.8–1.2) age 50–59 treatment 5 years; 1.1 (0.9–1.2) age 50–59 treatment 10 years; 1.0 (0.8–1.2) age 60–69 treatment 5 years; 1.1 (0.9–1.2) age 60–69 treatment 10 years	^26
Ovarian cancer	−1.1 (1.0–1.3) age 50–59 treatment 5 years; −1.3 (1.1–1.5) age 50–59 treatment 10 years; −1.1 (1.0–1.3) age 60–69 treatment 5 years; −1.3 (1.1–1.5) age 60–69 treatment 10 years	^26
Stroke	1.14 (1.04–1.25)	^34
Coronary heart disease	1.02 (0.94–1.10)	^34
Venous thrombo-embolic events	1.70 (1.33–2.16)	^34
Fracture of femur	0.80 (0.68–0.94)	^35
Mortality parameters
Breast cancer	0.21633	^36
Endometrial cancer	0.15284	^37
Ovarian cancer	0.29835	^37
Coronary heart disease	0.37735	^38**
Stroke	0.37735	^38
Venous thrombo-embolic events	0.12445	^39
Fracture of femur	0.03478	^40

* DRG code for OVCA not provided therefore ENDOCA used as proxy;

∼sum of genitourinary syndrome of menopause (GSM) and depression of menopause;

** no data specific to China available therefore used same data for stroke as proxy.

Figure 2. Tornado diagram of the univariate deterministic sensitivity analysis showing the variation in absolute ICER for parameters influencing the results more than one percent.

Table 2. Incremental cost utility results for deterministic range of scenarios.

Scenario	Regimen	Cost $ (Yuan)	QALY	ICER $/QALY (¥/QALY)
Base case sequential treatment five years duration, start age 45 yrs, disease risk from multiple sources, cost data from C-DRG, utility data from literature review; societal perspective.	No MHT	30,824 (205,495)	11.16
	MHT	22,516 (150,106)	12.31
	Difference	−8,308 (−55,389)	1.15	−7,189 (−47,928)
Sequential treatment ten years duration, start age 45 yrs, disease risk from multiple sources, cost data from C-DRG, utility data from literature review; societal perspective.	No MHT	29,843 (198,956)	11.23
	MHT	21,821 (145,474)	12.42
	Difference	−8,022 (−53,482)	1.18	−6,785 (−45,230)
Sequential treatment five years duration, start age 50 yrs, disease risk from multiple sources, cost data from C-DRG, utility data from literature review; societal perspective.	No MHT	26,999 (179,992)	9.85
	MHT	19,648 (130,986)	10.88
	Difference	−7,351 (-49,006)	1.03	−7,165 (−47,767)
Sequential treatment five years duration, start age 55 yrs, disease risk from multiple sources, cost data from C-DRG, utility data from literature review; societal perspective.	No MHT	20,417 (136,115)	8.40
	MHT	14,164 (94,429)	9.28
	Difference	−6,253 (−41,685)	0.88	−7,108 (−47,385)
Sequential treatment five years duration, start age 60 yrs, disease risk from multiple sources, cost data from C-DRG, utility data from literature review; societal perspective.	No MHT	11,596 (77,305)	6.82
	MHT	6,575 (43,835)	7.53
	Difference	−5,021 (−33,471)	0.72	−6,994 (−46,627)
Sequential treatment five years duration, start age 45 yrs, disease risk from single source (MHRA), cost data from C-DRG, utility data from literature review; societal perspective.	No MHT	30,594 (203,958)	11.16
	MHT	22,676 (151,170)	12.28
	Difference	−7,918 (−52,788)	1.12	−7,090 (−47,265)
Sequential treatment five years duration, start age 45 yrs, disease risk from multiple sources, cost data from literature review, utility data from literature review; societal perspective.	No MHT	20,822 (138,816)	11.16
	MHT	21,986 (146,572)	12.31
	Difference	1,163 (7,756)	1.16	1,007 (6,711)
Sequential treatment five years duration, start age 45 yrs, disease risk from multiple sources, cost data from C-DRG, utility data constant disutility for all health states; societal perspective.	No MHT	30,824 (205,495)	11.16
	MHT	22,516 (150,106)	12.32
	Difference	−8,308 (−55,389)	1.16	−7,183 (−47,884)
Sequential treatment five years duration, start age 45 yrs, disease risk from multiple sources, cost data from C-DRG, utility data variable ranked utility for health states; societal perspective.	No MHT	30,824 (205,495)	11.16
	MHT	22,516 (150,106)	12.32
	Difference	−8,308 (−55,389)	1.16	−7,185 (−47,898)
Sequential treatment five years duration, start age 45 yrs, disease risk from multiple sources, cost data from C-DRG, utility data literature review; healthcare payer perspective.	No MHT	10,164 (67,757)	11.16
	MHT	1,488 (9,917)	12.31
	Difference	−8,676 (−57,840)	1.16	−7,507 (−50,048)

Underlined indicates that the parameter has been changed in this scenario. Abbreviations. yrs, years; MHT, menopausal hormone therapy; C-DRG, China diagnosis related groups.

Figure 3. Scatterplot of probabilistic sensitivity analysis (PSA) for 1,000 iterations of Monte Carlo simulation for the base case analysis (Yuan).

Figure 4. Cost effectiveness acceptability curve (CEAC) for 1,000 iterations of Monte Carlo simulation for the base case analysis (Yuan).

China diagnosis related group codes and data provided by Abbott Affiliate. 2020.

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