The levonorgestrel intrauterine system versus endometrial ablation for heavy menstrual bleeding: a cost-effectiveness analysis

Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands. Department of General Practice, University of Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands. Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands. Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands. Department of Obstetrics and Gynaecology, Grow Research School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands.

BJOG : an international journal of obstetrics and gynaecology. 2021

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Abstract
OBJECTIVE To evaluate the costs and non-inferiority of a strategy starting with the LNG-IUS compared to endometrial ablation (EA) in the treatment of heavy menstrual bleeding (HMB). DESIGN Cost-effectiveness analysis from a societal perspective alongside a multicentre randomised non-inferiority trial. SETTING General practices and gynaecology departments in the Netherlands. POPULATION 270 women with HMB, aged ≥34 years old, without intracavitary pathology or future child wish. METHODS Randomisation to a strategy starting with the LNG-IUS (n=132) or EA (n=138). The incremental cost-effectiveness ratio (ICER) was estimated. MAIN OUTCOME MEASURES Direct medical costs and (in)direct non-medical costs were calculated. The primary outcome was menstrual blood loss after 24 months, measured with the mean Pictorial Blood Assessment Chart (PBAC)-score (non-inferiority margin 25 points). A secondary outcome was successful blood loss reduction (PBAC-score ≤75 points). RESULTS Total costs per patient were €2,285 in the LNG-IUS strategy and €3,465 in the EA strategy (difference: €1,180). At 24 months mean PBAC-scores were 64.8 in the LNG-IUS group (N=115) and 14.2 in the EA group (N=132); difference 50.5 points (95% CI: 4.3-96.7). In the LNG-IUS group, 87% of women had a PBAC-score ≤75 points versus 94% in the EA group (RR 0.93, 95% CI: 0.85-1.01). The ICER was €23 (95% CI: €5-€111) per PBAC-point. CONCLUSIONS A strategy starting with the LNG-IUS was cheaper than starting with EA, but non-inferiority could not be demonstrated. The LNG-IUS is reversible and less invasive and can be a cost-effective treatment option, depending on the success rate women are willing to accept.
Study details
Language : eng
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