The effectiveness and cost-effectiveness of microwave and thermal balloon endometrial ablation for heavy menstrual bleeding: a systematic review and economic modelling

Garside, Ruth; Stein, Ken; Wyatt, Katrina; Round, Alison; Price, Alison

doi:10.3310/hta8030

Cited by 56 publications

(65 citation statements)

References 66 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The international literature contains some similar studies which compare the different surgical techniques [23][24] , and some included LNG-IUS [25][26][27][28][29] , although none of the studies may be directly comparable to this one.…”

Section: Commentsmentioning

confidence: 99%

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

Lete

Cristóbal

Febrer³

et al. 2011

European Journal of Obstetrics & Gynecology and Reproductiv

View full text Add to dashboard Cite

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

show abstract

Section: Commentsmentioning

confidence: 99%

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

Lete

Cristóbal

Febrer³

et al. 2011

European Journal of Obstetrics & Gynecology and Reproductiv

View full text Add to dashboard Cite

show abstract

“…While the use of a similar tool to measure subjective satisfaction for women in both arms of an RCT may provide a comparative measure between these groups, it may remain unclear exactly what is being measured for the reasons outlined above. 16 In addition, the range of techniques and scales used to elicit a measure of satisfaction across studies can limit any attempts to aggregate data by means of meta-analysis.…”

Section: Measuring Patient Satisfactionmentioning

confidence: 99%

“…It is not clear whether satisfaction can be measured on a continuum, from dissatisfied through to satisfied, or whether factors resulting in satisfaction are different from those leading to dissatisfaction. 16 Satisfaction is influenced by patient characteristics 24 such as age and health status.…”

Section: Measuring Patient Satisfactionmentioning

confidence: 99%

“…Generic measures of QoL used in HMB include the Short Form questionnaire-36 items (SF-36), Nottingham Health Profile, health-status structured history and single global item. 16 SF-36 is generally a well-validated measure used to assess health-related QoL 19 and includes items on global health perception, physical function, social function, role (physical and mental), pain, mental health and energy/vitality. 20 The SF-36 has been considered to be a feasible way of assessing QoL in women with HMB, but it has some limitations in this setting 21 as some questions can be inappropriate for these women.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hysterectomy, endometrial ablation and Mirena® for heavy menstrual bleeding: a systematic review of clinical effectiveness and cost-effectiveness analysis

Bhattacharya

Middleton²,

Tsourapas³

et al. 2011

Health Technol Assess

100

View full text Add to dashboard Cite

How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address.Paying by credit card You can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume.How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment programmeThe Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service' . The HTA programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of project...

show abstract

“…Hysteroscopic endometrial ablation or resection and more recently "second generation" devices such as balloon or microwave ablation offer a day-case surgical alternative to hysterectomy [6][7][8][9] The gold standard techniques (laser, trans-cervical endometrial resection and roller-ball) are safe hysteroscopic techniques for endometrial ablation, which require adequate visualization of uterine cavity and skilled surgeons [4]. Trans-vaginal Color Doppler ultrasonography enables us to discover the changes which occur in the uterine arteries blood flow after hysteroscopic endometrial ablation.…”

mentioning

confidence: 99%

Outcome and Hemodynamic Alternation in Uterine Artery Following Hysteroscopic Roller-Ball Endometrial Ablation

Abdelazim¹,

Ma²,

S³

2015

Journal of Gynecology Research

View full text Add to dashboard Cite

Objectives: To detect the outcome and changes in uterine arteries blood flow after hysteroscopic roller-ball endometrial ablation. [2,3]. HMB is a significant health problem in premenopausal women, it can cause anemia and reduce quality of life [4]. Menorrhagia is one of the most common causes for referral of pre-menopausal women to gynecologists, and, inspite of medical therapy, many women will eventually require hysterectomy [4,5]. Hysterectomy is invasive option associated with significant in-patient hospitalization for many women [4,5]. Introduction Outcome and Hemodynamic Alternation in Uterine ArteryMethods: 84 women with menorrhagia refused to continue or had failed medical treatment with uterine size <12 weeks were included in this study. Diagnostic hysteroscopy was done for women included in this study prior to endometrial ablation. A rigid operative hysteroscopy, with normal saline distention media and roller-ball electrode were used for endometrial ablation procedure. Preoperative findings of studied women including Doppler findings were compared to 3, 6 and 12 months post-operative findings to detect outcome and changes in uterine arteries blood flow after hysteroscopic roller-ball endometrial ablation.Results: 77/84 (91.7%) women were satisfied and their HMB was improved after rollerball endometrial ablation (33/84 (39.30%) amenorrhea, 27/84 (32.14%) hypo-menorrhea and 17/84 (20.24%) euomenorrhea = normal menstrual flow). ED (End Diastolic velocity), (9.2±7.4 cm/s before ablation) was significantly decreased 6 and 12 months after roller-ball endometrial ablation (5.0±6.0 and 4.6±6.1; respectively), also, TAMX (Time-averaged maximum velocity), (21.8±8.2 cm/s before ablation) was significantly decreased 6 and 12 months after roller-ball ablation (14.8±6.4 and 13.9±6.3; respectively). PI (Pulsatiliy Index), (1.32±0.5 cm/s before ablation) was significantly increased 6 and 12 months after roller-ball ablation (1.64±0.45 and 1.69±0.4; respectively), also, RI (Resistance Index), (0.80±0.2 cm/s before ablation) was significantly increased 3, 6 and 12 months after roller-ball ablation (0.84±0.4, 0.89±0.2 and 0.90±0.3; respectively). Conclusion:Hysteroscopic roller-ball endometrial ablation is a safe and effective therapeutic option for selected cases of menorrhagia. It increases stiffness and decreases mobility of uterine arteries during cardiac cycle, also, it induces rise in impedance with subsequent decrease in uterine blood flow and menstrual flow which completed 6-12 months following ablation procedure.

show abstract

The effectiveness and cost-effectiveness of microwave and thermal balloon endometrial ablation for heavy menstrual bleeding: a systematic review and economic modelling

Cited by 56 publications

References 66 publications

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

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

Hysterectomy, endometrial ablation and Mirena® for heavy menstrual bleeding: a systematic review of clinical effectiveness and cost-effectiveness analysis

Outcome and Hemodynamic Alternation in Uterine Artery Following Hysteroscopic Roller-Ball Endometrial Ablation

Contact Info

Product

Resources

About