The levonorgestrel intrauterine system versus endometrial ablation for heavy menstrual bleeding: a cost‐effectiveness analysis
| Autor: | Marian J van den Brink, Peggy M.A.J. Geomini, Marlies Y. Bongers, Pleun Beelen, Malou C. Herman, Marjolein Y. Berger, Karin M. Vermeulen, Janny H. Dekker |
|---|---|
| Přispěvatelé: | RS: GROW - R4 - Reproductive and Perinatal Medicine, Obstetrie & Gynaecologie, MUMC+: MA Medische Staf Obstetrie Gynaecologie (9), Life Course Epidemiology (LCE), Value, Affordability and Sustainability (VALUE) |
| Rok vydání: | 2021 |
| Předmět: |
economic evaluation
Cost-Benefit Analysis medicine.medical_treatment Quality of life QUALITY-OF-LIFE Levonorgestrel Cost‐effective analysis Research Articles Netherlands mirena UTILITY OUTCOMES education.field_of_study Obstetrics Intrauterine Devices Medicated WOMEN Obstetrics and Gynecology Cost-effectiveness analysis intrauterine device noninferiority trial Treatment Outcome Endometrial ablation HYSTERECTOMY Female HEALTH menstruation BURDEN Research Article medicine.drug Adult endocrine system medicine.medical_specialty SF-36 Cost-effective analysis CLINICAL EFFECTIVENESS Population MENORRHAGIA Intrauterine device Health Economics medicine Humans education Endometrial Ablation Techniques Hysterectomy novasure business.industry excessive uterine bleeding business |
| Zdroj: | Bjog-an International Journal of Obstetrics and Gynaecology, 128(12), 2003-2011. Wiley Bjog BJOG : An International Journal of Obstetrics and Gynaecology. Wiley |
| ISSN: | 1471-0528 1470-0328 |
| Popis: | Objective To evaluate the costs and non‐inferiority of a strategy starting with the levonorgestrel intrauterine system (LNG‐IUS) compared with 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 In all, 270 women with HMB, aged ≥34 years old, without intracavitary pathology or wish for a future child. Methods Randomisation to a strategy starting with the LNG‐IUS (n = 132) or EA (n = 138). The incremental cost‐effectiveness ratio 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 (relative risk [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. Tweetable abstract Treatment of heavy menstrual bleeding starting with LNG‐IUS is cheaper but slightly less effective than endometrial ablation. Tweetable abstract Treatment of heavy menstrual bleeding starting with LNG‐IUS is cheaper but slightly less effective than endometrial ablation. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text