Hysterectomy, endometrial ablation, and levonorgestrel releasing intrauterine system (Mirena) for treatment of heavy menstrual bleeding: cost effectiveness analysis

T E Roberts, A Tsouparas, L J Middleton, R Champaneria, J P Daniels, K G Cooper, S Bhattacharya, P M Barton

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Abstract

Objective To undertake a cost effectiveness analysis comparing first and second generation endometrial ablative techniques, hysterectomy, and the levonorgestrel releasing intrauterine system (Mirena) for treating heavy menstrual bleeding. Design Model based economic evaluation with data from an individual patient data meta-analysis supplemented with cost and outcome data from published sources taking an NHS (National Health Service) perspective. A state transition (Markov) model was developed, the
structure being informed by the reviews of the trials and clinical input. A subgroup analysis, one way sensitivity analysis, and probabilistic sensitivity analysis were also carried out. Population Four hypothetical cohorts of women with heavy menstrual bleeding.
Interventions One of four alternative strategies: Mirena, first or second generation endometrial ablation techniques, or hysterectomy.
Main outcome measures Cost effectiveness based on incremental cost per quality adjusted life year (QALY). Results Hysterectomy is the preferred strategy for the first intervention for heavy menstrual bleeding. Although hysterectomy is more expensive, it produces more QALYs relative to other remaining strategies and is likely to be considered cost effective. The incremental cost
effectiveness ratio for hysterectomy compared with Mirena is £1440 (€1633, $2350) per additional QALY. The incremental cost effectiveness ratio for hysterectomy compared with second generation ablation is £970 per additional QALY. Conclusion In light of the acceptable thresholds used by the National Institute for Health and Clinical Excellence, hysterectomy would be considered the preferred strategy for the treatment of heavy menstrual bleeding. The results concur with those of other studies but are highly sensitive to utility values used in the analysis.
Original languageEnglish
Article numberd2202
Number of pages10
JournalBritish Medical Journal
Volume342
Issue number-
Early online date26 Apr 2011
DOIs
Publication statusPublished - 26 Apr 2011

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