Quality of life was higher, and costs were lower, with the levonorgestrel-releasing intrauterine system for treatment of heavy menstrual bleeding than with three other common treatments, according to data from a model and a hypothetical population of 100,000 premenopausal women. The findings were published online in the American Journal of Obstetrics and Gynecology.
Robert Boston/Washington University
“As health systems and policies continue to emphasize value-based treatment decisions, it is important to give physicians and patients the tools to understand the health and economic trade-offs associated with each of these options,” Jennifer C. Spencer of the University of North Carolina, Chapel Hill, and her colleagues wrote (Am J Obstet Gynecol. 2017 Jul 25. doi: 10.1016/j.ajog.2017.07.024).
Overall, LNG-IUS was superior to hysterectomy and both types of endometrial ablation in terms of cost and quality of life, although quality of life scores were similar across all four treatments.
LNG-IUS was cost effective, compared with hysterectomy, in 90% of scenarios. Both types of ablation were similarly more cost effective, compared with hysterectomy; resectoscopic endometrial ablation was more cost effective in 44% of scenarios, nonresectoscopic endometrial ablation was more cost effective in 53% of scenarios.
“The 5-year cost of women undergoing LNG-IUS was $4,500, about half the cost of endometrial ablation ($9,500) and about one-third the cost of hysterectomy ($13,500),” the researchers noted.
“Our analysis finds strong evidence in favor of LNG-IUS as a cost-saving, dominant alternative to hysterectomy for women with heavy menstrual bleeding,” they wrote.
If LNG-IUS is not an option, the model shows that hysterectomy resulted in better quality of life in the majority of simulations but is cost effective in just over half of the simulations, compared with either resectoscopic or nonresectoscopic ablation.
“The comparative cost effectiveness of endometrial ablation and hysterectomy highlights important trade-offs for patients and providers to consider when selecting between treatment options, such as the need for future procedures or the potential for rare, but serious, complications,” the researchers wrote.
No other studies on this topic have been conducted in the United States, but the findings are consistent with results from studies conducted outside the United States, the researchers wrote.
The study was limited by the short follow-up period and the inability to extend the model to women with large fibroids, polyps, or other uterine pathologies.
Two of the authors reported receiving grant funding from Pfizer for an unrelated study. Other authors reported serving as consultants for Teleflex Medical, Applied Medical, and Olympus.