دورية أكاديمية
أعرض في EDS

The levonorgestrel intrauterine system versus endometrial ablation for heavy menstrual bleeding: a cost-effectiveness analysis.

التفاصيل البيبلوغرافية
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: : Oxford : Wiley-Blackwell
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
الوصف
تدمد:1471-0528
DOI:10.1111/1471-0528.16836