Ulipristal acetate for pre-operative treatment of moderate-to-severe uterine fibroids in women of reproductive age in The Netherlands: cost minimization analysis and budget impact analysis

Figures & data

Figure 1. Schematic structure of the model.

Table 1. Dutch unit costs (€) for resources used.

Resource item	Description	Unit cost	Reference
Direct medical costs
GP visit	GP visits associated with the administration of the GnRH agonists	€29.73	Hakkaart-van Roijen et al.^18
Nurse in hospital outpatient  setting^a^,^b	The administration of some GnRH agonists was assumed to be done by a nurse in a hospital clinic, as suggested by the expert panel. The unit cost is the weighted average of the cost of a nurse per visit in an academic and a general hospital (12% vs 88%)	€19.33	Hakkaart-van Roijen et al.^18
District nurse in homecare^a^,^b	The administration of some of the GnRH agonists was assumed to be done by a district nurse (homecare), as suggested by the expert panel. The unit cost is estimated by assuming a 15-min visit of the district nurse	€17.26	Hak et al.^19
Treatment costs
Ulipristal acetate 5 mg daily  (monthly price)	Cost of 5 mg/daily of ulipristal acetate at submission (monthly, incl. VAT)	€147.62 (€5.27/day)	Manufacturer
Leuprolide 3.75 mg	Cost of 3.75 mg of leuprolide (monthly, incl. VAT)	€117.96	Hakkaart-van Roijen et al.^18
Goserelin 3.6mg^a	Cost of 3.6 mg of goserolin (monthly, incl. VAT)	€113.96	Hakkaart-van Roijen et al.^18
Triptorelin 3.75 mg^a	Cost of 3.75 mg of triptorelin (monthly incl. VAT, sensitivity analysis)	€123.02	Zorginstituut Nederland ^17
Leuprolide (Depot) 11.25 mg^a	Cost of 11.25 mg of leuprolide (3 months, incl. VAT, sensitivity analysis)	€280.23	Zorginstituut Nederland ^17
Direct non-medical costs
Kilometres traveled^a^,^b	Cost of 1 km traveled, as defined in the Manual for cost research	€0.21	Hak et al.^19
Cost of parking^a^,^b	Average parking cost, as defined in the Dutch manual for cost research	€3.20	Hak et al.^19
Indirect cost
Working hour^a^,^b	Average cost of one working hour lost	€29.73	Hak et al.^19

^a Parameters that were incorporated only in the sensitivity analysis.

^b Parameters that were incorporated only in the sensitivity analysis, using a societal perspective.

Table 2. Parameter limits used in the univariate sensitivity and scenario analysis.

Parameter	Base-case analysis	Sensitivity analysis		Source
		Lower limit	Upper limit
Duration of treatment	3 months	3 months	6 months	Expert panel
Treatment administration: UlipristalLeuprolide	100% oral   100% GP/0% nurse	100% oral   100% GP/0% nurse	100% oral   70% GP/30% nurse	Manufacturer   Expert panel
Indirect costs	No indirect costs included	No indirect costs included	Indirect costs included
Full time work	No productivity losses	Part time work at 75%	Part time work at 0% (100% full-time)	Portegijs and Keuzenkamp^20
Comparator treatment	Leuprolide	Scenario analysis: mix of GnRH agonists^a		Expert panel

^a Lower and upper limit not used (scenario).

Table 3. Budget impact analysis*.

Year	Proportion of patients treated with ulipristal acetate	Proportion of patients treated with leuprolide	Total costs ulipristal acetate	Total costs leuprolide	Total costs
Current treatment scenario (with ulipristal acetate not being a treatment option)
1st	0.00	1.00	€0.00	€4,218,095	€4,218,095
2nd	0.00	1.00	€0.00	€4,218,095	€4,218,095
3rd	0.00	1.00	€0.00	€4,218,095	€4,218,095
Scenario with ulipristal acetate being introduced as a treatment alternative besides leuprolide
1st	0.30	0.70	€1,264,808	€2,952,666	€4,217,475
2nd	0.40	0.60	€1,686,411	€2,530,857	€4,217,268
3rd	0.50	0.50	€2,108,014	€2,109,047	€4,217,061
				Total savings
				1st	€620
				2nd	€827
				3rd	€1,034

* Estimations based on assumptions that ulipristal acetate would be used by 30%, 40%, and 50% of the total number of eligible Dutch patients with uterine fibroids in the first, second, and third year, respectively.

Figure 2. Incremental annual total costs of ulipristal acetate compared to leuprolide in univariate sensitivity analysis.

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