目的:是否可以通过使用非标准给药方案来降低GnRH激动剂治疗子宫内膜异位症的成本?
结论:每6周而不是每4周注射3.75mg曲普瑞林储库制剂的延长间隔给药方案可将成本降低三分之一,而不会影响疼痛缓解效果。
背景:费用限制了GnRH激动剂的长期使用。已经尝试了减轻GnRH激动剂治疗经济负担的替代方法。
■进行了系统评价,以评估和比较子宫内膜异位症妇女使用GnRH的三种替代方式的效果。即间歇性雌激素剥夺疗法,减少药物剂量,和长效制剂的延长间隔给药方案。PubMed和Embase搜索最初于2022年10月进行,并于2023年1月使用以下搜索字符串进行更新:(子宫内膜异位症或子宫腺肌症)和(GnRH激动剂或促性腺激素释放激素激动剂或曲普瑞林或亮丙瑞林或戈舍瑞林或布塞林或纳福瑞林)。选择了自1980年1月1日以来在同行评审的期刊上以英文发表的全长文章,并报告了有关GnRH激动剂治疗与子宫内膜异位症相关的疼痛症状的原始数据。
方法:在研究设计中提取信息,使用GnRH激动剂,剂量,治疗的总持续时间,副作用,治疗依从性,和骨盆疼痛缓解。评论,评论,会议记录,病例报告,给编辑的信被排除在外。
结果:在筛选的1664条记录中,最终纳入了14项关于与GnRH激动剂使用的3种考虑的替代方式相关的临床结局的研究(间歇性雌激素剥夺治疗,n=2;低剂量或“回缩”疗法,n=8;延长间隔给药方案,n=4)。六项研究为随机对照试验(RCTs)(双盲,n=2)和8人采用了前瞻性队列设计(非比较,n=6;比较,n=2)。上述研究共招募了776名患有子宫内膜异位症的女性(间歇性雌激素剥夺治疗,n=77;低剂量或“收缩”疗法,n=528;延长间隔给药方案,n=171)。仅延长间隔给药方案可获得证明节约成本而没有有害临床后果的稳健数据。特别是,与3.75mg亮丙瑞林储库制剂相比,3.75mg曲普瑞林储库制剂抑制卵巢功能的时间更长,允许注射每6而不是4周。根据意大利医药机构指出的3.75毫克曲普瑞林仓库制剂的费用,这将转化为每年节省744.60欧元(2230.15-1485.55欧元;-33.4%)。
结论:所选文章中报告的证据质量未得到正式评估,无法进行定量综合。一些研究很古老,测试的治疗方法显然已经过时。仅控制与GnRH类似物使用相关的成本,而不是成本效益,已解决。
结论:消耗更少的资源而不对健康结果产生负面影响对个人和社区具有道德和实践意义。因为这种方法可能会导致全面增加医疗保健服务。
背景:这项研究得到了意大利卫生部的支持(RicercaCorrente2023,IRCCSCa\'GrandaOspedaleMaggiorePoliclinicoMilano)。E.S.披露了Ferring的研究补助金和Merck-Serono的讲座酬金。所有其他作者都声明他们没有利益冲突。
背景:不适用。
OBJECTIVE: Is it possible to reduce the cost of GnRH agonist treatment for endometriosis by using non-standard dosing regimens?
CONCLUSIONS: An extended-interval dosing regimen of a 3.75 mg depot formulation of triptorelin injected every 6 weeks instead of every 4 weeks reduces the cost by one-third without compromising the effect on pain relief.
BACKGROUND: Cost constitutes a limit to prolonged GnRH agonists use. Alternative modalities to reduce the economic burden of GnRH agonist treatment have been anecdotally attempted.
UNASSIGNED: A systematic review was conducted to evaluate and compare the effect of three alternative modalities for GnRH use in women with endometriosis, i.e. intermittent oestrogen deprivation therapy, reduced drug dosage, and extended-interval dosing regimens of depot formulations. A PubMed and Embase search was initially conducted in October 2022 and updated in January 2023 using the following search strings: (endometriosis OR adenomyosis) AND (GnRH-agonists OR gonadotropin-releasing hormone agonists OR triptorelin OR leuprorelin OR goserelin OR buserelin OR nafarelin). Full-length articles published in English in peer-reviewed journals since 1 January 1980, and reporting original data on GnRH agonist treatment of pain symptoms associated with endometriosis were selected.
METHODS: Information was extracted on study design, GnRH-agonist used, dosage, total duration of therapy, side effects, treatment adherence, and pelvic pain relief. Reviews, commentaries, conference proceedings, case reports, and letters to the editor were excluded.
RESULTS: Of the 1664 records screened, 14 studies regarding clinical outcomes associated with the 3 considered alternative modalities for GnRH agonist use were eventually included (intermittent oestrogen deprivation therapy, n = 2; low-dose or \'draw-back\' therapy, n = 8; extended-interval dosing regimen, n = 4). Six studies were randomized controlled trials (RCTs) (double blind, n = 2) and eight adopted a prospective cohort design (non-comparative, n = 6; comparative, n = 2). A total of 776 women with endometriosis were recruited in the above studies (intermittent oestrogen deprivation therapy, n = 77; low-dose or \'draw-back\' therapy, n = 528; extended-interval dosing regimen, n = 171). Robust data demonstrating cost saving without detrimental clinical consequences were available for the extended-interval dosing regimen only. In particular, the 3.75 mg triptorelin depot preparation inhibits ovarian function for a longer period compared with the 3.75 mg leuprorelin depot preparation, allowing injections every 6 instead of 4 weeks. Based on the cost indicated by the Italian Medicine Agency for the 3.75 mg triptorelin depot preparation, this would translate in a yearly saving of €744.60 (€2230.15-€1485.55; -33.4%).
CONCLUSIONS: The quality of the evidence reported in the selected articles was not formally evaluated and a quantitative synthesis could not be performed. Some studies were old and the tested therapeutic approaches were apparently obsolete. Only cost containment associated with GnRH analogue use, and not cost-effectiveness, has been addressed.
CONCLUSIONS: Consuming less resources without negatively impacting on health outcomes carries ethical and practical implications for individuals and the community, as this approach may result in overall increased healthcare access.
BACKGROUND: This study was supported by the Italian Ministry of Health (Ricerca Corrente 2023, IRCCS Ca\' Granda Ospedale Maggiore Policlinico Milano). E.S. discloses payments from Ferring for research grants and honoraria from Merck-Serono for lectures. All other authors declare they have no conflict of interest.
BACKGROUND: N/A.