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

• Published in: European journal of obstetrics & gynecology and reproductive biology 2011-01, Vol.154 (1), p.71-80
• Main Authors: Lete, I, Cristóbal, I, Febrer, L, Crespo, C, Arbat, A, Hernández, F.J, Brosa, M
• Format: Article
• Language: English
• Subjects: Anàlisi econòmica; Biological and medical sciences; Contraceptive Agents, Female - administration & dosage; Contraceptive Agents, Female - economics; Contraceptives, Oral, Combined - economics; Contraceptives, Oral, Combined - therapeutic use; Cost-Benefit Analysis; Cost–effectiveness analysis; Cost–utility analysis; Dysfunctional uterine bleeding; Economic analysis; Espanya; Female; Female genital diseases; Ginecologia; Gynecology; Gynecology. Andrology. Obstetrics; Heavy menstrual bleeding; Humans; Intrauterine Devices, Medicated - economics; Levonorgestrel - administration & dosage; Levonorgestrel - economics; Levonorgestrel-releasing intrauterine system; Medical sciences; Metrorrhagia - drug therapy; Models, Theoretical; Non tumoral diseases; Obstetrics and Gynecology; Progestins - economics; Progestins - therapeutic use; Quality of Life; Spain
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2010.08.019

Abstract Objective To compare the cost and effectiveness of the levonorgestrel-releasing intrauterine system (LNG-IUS) versus combined oral contraception (COC) and progestogens (PROG) in first-line treatment of 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 the 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 3%. In addition, a sensitivity analysis (univariate and probabilistic) was conducted. Results The results show that the greater efficacy of LNG-IUS translates into a gain of 1.92 and 3.89 symptom-free months (SFM) after six months of treatment versus COC and PROG, respectively (which represents an increase of 33% and 60% of 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 The results indicate that first-line use of the LNG-IUS is the dominant therapeutic option (less costly and more effective) in comparison with 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 health-related quality of life to patients.