Is Testosterone Replacement Therapy in Males with Hypogonadism Cost-Effective? An Analysis in Sweden
- 1 January 2014
- journal article
- review article
- Published by Oxford University Press (OUP) in The Journal of Sexual Medicine
- Vol. 11 (1), 262-272
- https://doi.org/10.1111/jsm.12277
Abstract
Testosterone replacement therapy (TRT) has been recommended for the treatment of primary and secondary hypogonadism. However, long-term implications of TRT have not been investigated extensively. The aim of this analysis was to evaluate health outcomes and costs associated with life-long TRT in patients suffering from Klinefelter syndrome and late-onset hypogonadism (LOH). A Markov model was developed to assess cost-effectiveness of testosterone undecanoate (TU) depot injection treatment compared with no treatment. Health outcomes and associated costs were modeled in monthly cycles per patient individually along a lifetime horizon. Modeled health outcomes included development of type 2 diabetes, depression, cardiovascular and cerebrovascular complications, and fractures. Analysis was performed for the Swedish health-care setting from health-care payer's and societal perspective. One-way sensitivity analyses evaluated the robustness of results. The main outcome measures were quality-adjusted life-years (QALYs) and total cost in TU depot injection treatment and no treatment cohorts. In addition, outcomes were also expressed as incremental cost per QALY gained for TU depot injection therapy compared with no treatment (incremental cost-effectiveness ratio [ICER]). TU depot injection compared to no-treatment yielded a gain of 1.67 QALYs at an incremental cost of 28,176 EUR (37,192 USD) in the Klinefelter population. The ICER was 16,884 EUR (22,287 USD) per QALY gained. Outcomes in LOH population estimated benefits of TRT at 19,719 EUR (26,029 USD) per QALY gained. Results showed to be considerably robust when tested in sensitivity analyses. Variation of relative risk to develop type 2 diabetes had the highest impact on long-term outcomes in both patient groups. This analysis suggests that lifelong TU depot injection therapy of patients with hypogonadism is a cost-effective treatment in Sweden. Hence, it can support clinicians in decision making when considering appropriate treatment strategies for patients with testosterone deficiency.This publication has 46 references indexed in Scilit:
- The 20-Year Public Health Impact and Direct Cost of Testosterone Deficiency in U.S. MenThe Journal of Sexual Medicine, 2013
- The Direct and Indirect Costs among U.S. Privately Insured Employees with HypogonadismThe Journal of Sexual Medicine, 2012
- Endogenous Testosterone and Mortality in Men: A Systematic Review and Meta-AnalysisJournal of Clinical Endocrinology & Metabolism, 2011
- Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice GuidelineJournal of Clinical Endocrinology & Metabolism, 2010
- Prediction of Metabolic Syndrome by Low Serum Testosterone Levels in MenDiabetes, 2009
- Investigation, Treatment, and Monitoring of Late‐Onset Hypogonadism in Males: ISA, ISSAM, EAU, EAA, and ASA RecommendationsJournal of Andrology, 2009
- Physical activity and quality of life in subjects with chronic disease: Chronic obstructive pulmonary disease compared with rheumatoid arthritis and diabetes mellitusScandinavian Journal of Primary Health Care, 2009
- Utility loss and indirect costs after stroke in SwedenEuropean Journal of Preventive Cardiology, 2008
- Which health-related quality of life score? A comparison of alternative utility measures in patients with Type 2 diabetes in the ADVANCE trialHealth and Quality of Life Outcomes, 2007
- Investigation, Treatment, and Monitoring of Late‐Onset Hypogonadism in Males: ISA, ISSAM, and EAU RecommendationsJournal of Andrology, 2006