Levonorgestrel-releasing intrauterine system vs. usual medical treatment for
menorrhagia: an economic evaluation alongside a randomised controlled trial.
Author(s): Sanghera S(1), Roberts TE(1), Barton P(1), Frew E(1), Daniels J(2), Middleton
L(3), Gennard L(3), Kai J(4), Gupta JK(5).
Affiliation(s): Author information:
(1)Health Economics Unit, University of Birmingham, Birmingham, United Kingdom.
(2)School of Clinical and Experimental Medicine, University of Birmingham,
Birmingham, United Kingdom; Birmingham Clinical Trials Unit, University of
Birmingham, Birmingham, United Kingdom. (3)Birmingham Clinical Trials Unit,
University of Birmingham, Birmingham, United Kingdom. (4)Division of Primary Care
& National Institute for Health Research, University of Nottingham, Nottingham,
United Kingdom. (5)School of Clinical and Experimental Medicine, University of
Birmingham, Birmingham, United Kingdom.
Publication date & source: 2014, PLoS One. , 9(3):e91891
OBJECTIVE: To undertake an economic evaluation alongside the largest randomised
controlled trial comparing Levonorgestrel-releasing intrauterine device
('LNG-IUS') and usual medical treatment for women with menorrhagia in primary
care; and compare the cost-effectiveness findings using two alternative measures
of quality of life.
METHODS: 571 women with menorrhagia from 63 UK centres were randomised between
February 2005 and July 2009. Women were randomised to having a LNG-IUS fitted, or
usual medical treatment, after discussing with their general practitioner their
contraceptive needs or desire to avoid hormonal treatment. The treatment was
specified prior to randomisation. For the economic evaluation we developed a
state transition (Markov) model with a 24 month follow-up. The model structure
was informed by the trial women's pathway and clinical experts. The economic
evaluation adopted a UK National Health Service perspective and was based on an
outcome of incremental cost per Quality Adjusted Life Year (QALY) estimated using
both EQ-5D and SF-6D.
RESULTS: Using EQ-5D, LNG-IUS was the most cost-effective treatment for
menorrhagia. LNG-IUS costs £100 more than usual medical treatment but generated
0.07 more QALYs. The incremental cost-effectiveness ratio for LNG-IUS compared to
usual medical treatment was £1600 per additional QALY. Using SF-6D, usual medical
treatment was the most cost-effective treatment. Usual medical treatment was both
less costly (£100) and generated 0.002 more QALYs.
CONCLUSION: Impact on quality of life is the primary indicator of treatment
success in menorrhagia. However, the most cost-effective treatment differs
depending on the quality of life measure used to estimate the QALY. Under UK
guidelines LNG-IUS would be the recommended treatment for menorrhagia. This study
demonstrates that the appropriate valuation of outcomes in menorrhagia is
crucial.
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