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Randomized Controlled Trial
. 2014 Mar 17;9(3):e91891.
doi: 10.1371/journal.pone.0091891. eCollection 2014.

Levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: an economic evaluation alongside a randomised controlled trial

Sabina Sanghera  1 , Tracy Elizabeth Roberts  1 , Pelham Barton  1 , Emma Frew  1 , Jane Daniels  2 , Lee Middleton  3 , Laura Gennard  3 , Joe Kai  4 , Janesh Kumar Gupta  5
Affiliations
Randomized Controlled Trial

Levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: an economic evaluation alongside a randomised controlled trial

Sabina Sanghera et al. PLoS One. .

Abstract

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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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Clinical pathway for LNG-IUS and usual medical treatment.
Figure 2
Figure 2. Results of the probabilistic sensitivity analysis (EQ-5D).
Figure 3
Figure 3. Cost-effectiveness acceptability curves for usual medical treatment and LNG-IUS using EQ-5D.
Figure 4
Figure 4. Results of the probabilistic sensitivity analysis (SF-6D).
Figure 5
Figure 5. Cost-effectiveness acceptability curves for usual medical treatment and LNG-IUS using SF-6D.
See this image and copyright information in PMC

References

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