Economic evaluation of the levonorgestrel-releasing intrauterine system for the treatment of dysfunctional uterine bleeding in Spain

Abstract

Objective: To compare the efficiency of the levonorgestrel-releasing intrauterine system (LNG-IUS) versus combined oral contraception (COC) and progestogens (PROG) in first-line treatment for dysfunctional uterine bleeding (DUB) in Spain. Study Design: A cost-effectiveness and cost-utility analysis of LNG-IUS, COC and PROG was carried out using a Markov model based on clinical data from literature and expert opinion. The population studied were women with a previous diagnosis of idiopathic heavy menstrual bleeding. The analysis was performed from the National Health System perspective, discounting both costs and future effects at the 3%. In addition, a sensitivity analysis (univariate and probabilistic) was conducted. Results: Results show that the greater efficacy of LNG-IUS translates into a gain of 1.92 and 3.89 symptom-free months (SFM) after 6 months of treatment, respectively, versus COC and PROG (which represents an increase of 33% and 60% of the symptom-free time). Regarding costs, LNG-IUS produces savings of 174.2-309.95 € and 230.54-577.61 € versus COC and PROG respectively, after 6 months-5 years. Apart from cost savings and gains in SFM, quality-adjusted life months (QALM) are also favourable to LNG-IUS in all scenarios, with a range of gains between 1 and 2 QALM compared to COC and PROG. Conclusions: Results indicate that the first-line use of LNG-IUS is the dominant therapeutic option (less costly and more effective) in comparison with the first-line use of COC or PROG for the treatment of DUB in Spain. LNG-IUS as first line is also the option that provides greatest quality of life to patients. Study Design: A cost-effectiveness and cost-utility analysis of LNG-IUS, COC and PROG was carried out using a Markov model based on clinical data from literature and expert opinion. The population studied were women with a previous diagnosis of idiopathic heavy menstrual bleeding.The analysis was performed from the National Health System perspective, discounting both costs and future effects at the 3%. In addition, a sensitivity analysis (univariate and probabilistic) was

The Cost-Effectiveness of the Levonorgestrel-Releasing Intrauterine System for the Treatment of Idiopathic Heavy Menstrual Bleeding in the United States

“…Blumenthal et al [15] reported that LNG-IUS was the most cost-effective treatment strategy, when assessed using bleeding treatment and contraceptive success, for managing dysfunctional uterine bleeding from a US perspective among women who previously responded to oral contraceptive therapy (it should be noted, however, that this model grouped branded and generic COCs together and used outdated costs). Our results are also consistent with findings from studies conducted in Hong Kong [11], Spain [13], and the United Kingdom [12,14] that showed that LNG-IUS was more cost-effective than oral treatments and, in most cases, ablation, as well as with a recent literature review on the cost-effectiveness and quality of life associated with the use of LNG-IUS as a treatment for HMB [26].…”

“…Although a number of trials have established the clinical evidence for the use of these treatment options [6][7][8][9][10], economic evidence is also needed to ensure efficient allocation of limited health care resources. A few studies, from perspectives other than the US health care payers, have investigated the costeffectiveness and cost-utility of these treatments for women with HMB who also desire contraception [11][12][13][14]. Only one study, by Blumenthal et al [15], has examined the cost-effectiveness of LNG-IUS, oral contraceptives, and surgical management of idiopathic HMB in the US population by considering three scenarios: women who have previously responded to a 3-month trial of COCs, women who did not respond to COCs, and women naive to medical therapy.…”

Levonorgestrel-Releasing Intrauterine System versus Medical Therapy for Menorrhagia: A Systematic Review and Meta-Analysis

“…However, due to its invasiveness, hysterectomy should not be considered a first-line treatment. Another study demonstrated that initial use of the LNG-IUS was less costly and more effective compared with combined oral conception or progestogens for the treatment of dysfunctional uterine bleeding [ 47 ]. However, there are only limited data available on long-term follow-up.…”

Análisis de la costo-efectividad del sistema intrauterino liberador de levonorgestrel, como alternativa a histerectomías, en dos países latinoamericanos

“…9 Los análisis de costo -efectividad del SIU-LNG en SUA, ya sea costo -minimización, costo -efectividad o costo -utilidad, han arrojado un positivo balance. [10][11][12][13] Sin embargo, con el fin de incluirlo en guías nacionales, cada país debe hacer un análisis fármaco-económico y verificar su viabilidad económica local.…”