دورية أكاديمية
The levonorgestrel intrauterine system versus endometrial ablation for heavy menstrual bleeding: a cost-effectiveness analysis.
العنوان: | The levonorgestrel intrauterine system versus endometrial ablation for heavy menstrual bleeding: a cost-effectiveness analysis. |
---|---|
المؤلفون: | van den Brink MJ; Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands., Beelen P; Department of General Practice, University of Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.; Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands., Herman MC; Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands., Geomini PM; Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands., Dekker JH; Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands., Vermeulen KM; Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands., Bongers MY; Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands.; Department of Obstetrics and Gynaecology, Grow Research School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands., Berger MY; Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands. |
المصدر: | BJOG : an international journal of obstetrics and gynaecology [BJOG] 2021 Nov; Vol. 128 (12), pp. 2003-2011. Date of Electronic Publication: 2021 Jul 27. |
نوع المنشور: | Equivalence Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
اللغة: | English |
بيانات الدورية: | Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 100935741 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1471-0528 (Electronic) Linking ISSN: 14700328 NLM ISO Abbreviation: BJOG Subsets: MEDLINE |
أسماء مطبوعة: | Publication: Original Publication: Oxford [England] : Blackwell Science, [2000]- |
مواضيع طبية MeSH: | Endometrial Ablation Techniques/*economics , Intrauterine Devices, Medicated/*economics , Levonorgestrel/*economics , Menorrhagia/*economics , Menorrhagia/*therapy, Adult ; Cost-Benefit Analysis ; Female ; Humans ; Levonorgestrel/administration & dosage ; Netherlands ; Treatment Outcome |
مستخلص: | 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. (© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.) |
التعليقات: | Comment in: BJOG. 2021 Nov;128(12):2012. (PMID: 34245654) |
References: | BJOG. 2016 Sep;123(10):1593-8. (PMID: 27240106) Qual Health Care. 1996 Mar;5(1):9-12. (PMID: 10157276) PLoS One. 2014 Mar 17;9(3):e91891. (PMID: 24638071) BJOG. 2011 Nov;118(12):1528-31. (PMID: 21790952) Aust Fam Physician. 2016 Nov;45(11):837-841. (PMID: 27806455) Br J Obstet Gynaecol. 1998 Nov;105(11):1155-9. (PMID: 9853763) Eur J Obstet Gynecol Reprod Biol. 2015 Jan;184:24-31. (PMID: 25462215) Value Health. 2013 Mar-Apr;16(2):325-33. (PMID: 23538185) Health Technol Assess. 2011 Apr;15(19):iii-xvi, 1-252. (PMID: 21535970) BJOG. 2017 Jan;124(2):277-282. (PMID: 28012272) J Health Econ. 2002 Mar;21(2):271-92. (PMID: 11939242) JAMA. 2004 Mar 24;291(12):1456-63. (PMID: 15039412) J Grad Med Educ. 2015 Mar;7(1):9-11. (PMID: 26217412) Soc Sci Med. 2013 Dec;98:149-53. (PMID: 24331893) Int Urogynecol J. 2019 Jul;30(7):1045-1059. (PMID: 30715575) Am J Obstet Gynecol. 2017 Nov;217(5):574.e1-574.e9. (PMID: 28754438) Fam Pract. 2017 Nov 16;34(6):673-678. (PMID: 28586411) Acta Obstet Gynecol Scand. 2014 Mar;93(3):225-32. (PMID: 24180560) Obstet Gynecol. 2002 Oct;100(4):683-7. (PMID: 12383534) BJOG. 2006 Jul;113(7):797-803. (PMID: 16827763) Womens Health Issues. 2009 Jan-Feb;19(1):70-8. (PMID: 19111789) BMJ. 2011 Apr 26;342:d2202. (PMID: 21521730) Health Technol Assess. 2015 Oct;19(88):i-xxv, 1-118. (PMID: 26507206) Med Care. 2012 Jul;50(7):627-32. (PMID: 22456112) Med Care. 1992 Jun;30(6):473-83. (PMID: 1593914) Obstet Gynecol. 2011 Dec;118(6):1287-1292. (PMID: 22105257) BJOG. 2021 Nov;128(12):2003-2011. (PMID: 34245652) Int J Gynaecol Obstet. 2015 Mar;128(3):196-200. (PMID: 25627706) J Womens Health (Larchmt). 2012 May;21(5):539-47. (PMID: 22360696) N Engl J Med. 2013 Jan 10;368(2):128-37. (PMID: 23301731) Cochrane Database Syst Rev. 2003;(2):CD003855. (PMID: 12804492) Curr Med Res Opin. 2007 Jul;23(7):1637-48. (PMID: 17559758) Gynecol Endocrinol. 2009 Oct;25(10):668-73. (PMID: 19657812) Am J Obstet Gynecol. 2021 Feb;224(2):187.e1-187.e10. (PMID: 32795428) BJOG. 2004 Oct;111(10):1103-14. (PMID: 15383113) Acta Obstet Gynecol Scand. 2017 Jan;96(1):19-28. (PMID: 27861709) BMC Womens Health. 2013 Aug 08;13:32. (PMID: 23927387) J Obstet Gynaecol Can. 2013 Nov;35(11):1010-1019. (PMID: 24246401) Br J Obstet Gynaecol. 1990 Aug;97(8):734-9. (PMID: 2400752) Br J Obstet Gynaecol. 1991 Aug;98(8):789-96. (PMID: 1911587) Value Health. 2007 May-Jun;10(3):183-94. (PMID: 17532811) BMJ. 2005 Apr 23;330(7497):938-9. (PMID: 15695496) |
معلومات مُعتمدة: | 171202001 Netherlands ZONMW_ ZonMw |
فهرسة مساهمة: | Keywords: Cost-effective analysis; economic evaluation; excessive uterine bleeding; intrauterine device; menorrhagia; menstruation; mirena; noninferiority trial; novasure |
المشرفين على المادة: | 5W7SIA7YZW (Levonorgestrel) |
تواريخ الأحداث: | Date Created: 20210710 Date Completed: 20211117 Latest Revision: 20211117 |
رمز التحديث: | 20240628 |
مُعرف محوري في PubMed: | PMC8518490 |
DOI: | 10.1111/1471-0528.16836 |
PMID: | 34245652 |
قاعدة البيانات: | MEDLINE |
تدمد: | 1471-0528 |
---|---|
DOI: | 10.1111/1471-0528.16836 |