Cost-effectiveness of dienogest compared to gonadotropin releasing hormone agonists for the management of endometriosis in Vietnam

Abstract

Objectives: Endometriosis-related dysmenorrhea and pelvic pain impose significant economic and quality-of-life burdens. This study evaluated the cost-effectiveness of dienogest compared to gonadotropin-releasing hormone agonists (GnRH-a) for managing dysmenorrhea and pelvic pain in Vietnam. Design: The cost-effectiveness analysis using a Markov model was conducted from a healthcare payer perspective. Model input parameters were obtained from meta-analyses, published literature, and local data sources. One-way sensitivity, and probabilistic sensitivity analyses (PSA) were performed to assess the robustness of the findings. Setting: Vietnamese healthcare system context. Participants: Hypothetical cohort of women with endometriosis experiencing dysmenorrhea or pelvic pain. Interventions: Dienogest compared with GnRH-a therapies (triptorelin, leuprorelin, goserelin). Main outcome measures: Costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated over two years. Results: Dienogest was the dominant treatment for dysmenorrhea, with the lowest cost ($363.3) and highest QALYs (1.74) compared to triptorelin ($739.3; 1.62 QALYs; ICER −$3,292/QALY) and leuprorelin ($744.0; 1.70 QALYs; ICER −$11,454/QALY). For pelvic pain, dienogest ($381.5, 1.64 QALYs) also dominated triptorelin ($720.4; 1.60 QALYs; ICER −$10,919/QALY), leuprorelin ($773.4; 1.54 QALYs; ICER −$4,300/QALY), and goserelin ($753.1; 1.49 QALYs; ICER −$2,609/QALY).One-way sensitivity analysis identified the probability of symptom resolution and utility values as key drivers of cost-effectiveness. PSA confirmed dienogest’s high probability (≥ 99%) of being cost-effective at a willingness-to-pay threshold of one GDP per capita. Conclusion: Dienogest is a cost-effective alternative to GnRH-a drugs for treating dysmenorrhea and pelvic pain in Vietnam, offering improved health outcomes at a lower cost. These findings support its broader adoption in clinical practice and healthcare policy.