A cost-utility analysis of hysterectomy, endometrial resection and ablation and medical therapy for menorrhagia.
BACKGROUND
Four types of treatment [hysterectomy, endometrial resection/ablation, levonorgestrel-releasing intrauterine system (LNG-IUS) and oral medical therapy] are available for management of menorrhagia. The objective of this study was to compare the cost and quality-adjusted life-years (QALYs) gained by these four treatment alternatives.


METHODS
A Markov model was designed to simulate the healthcare resource utilization and QALYs of the four treatment alternatives for patients presenting with menorrhagia over 5 years. Clinical inputs were estimated from literature, and the cost analysis was conducted from the perspective of healthcare provider in Hong Kong.


RESULTS
The base-case analysis showed that the hysterectomy group was the most effective (4.725 QALYs) alternative with the highest cost (USD6878, 1USD=7.8HKD). The incremental cost per additional QALY (ICER) gained by hysterectomy was USD23 500. The probability of extra surgery in the endometrial resection/ablation was an influential factor. Probabalistic sensitivity analysis of 10,000 simulations of the Monte Carlo model showed that the hysterectomy group gained higher number of QALYs than the LNG-IUS, oral medical treatment and endometrial resection/ablation groups, 99, 99 and 98% of the time, and it was more costly than the other three groups over 85% of the time.


CONCLUSIONS
Hysterectomy appears to be cost effective, with ICER less than USD50,000, for management of menorrhagia.
You
Joyce H S
JH
Centre for Pharmacoeconomics Research, School of Pharmacy, The Chinese University of Hong Kong, China. joyceyou@cuhk.edu.hk
Sahota
Daljit Singh
DS
MoYuen
Pong
P
D000328:Adult; D003362:Cost-Benefit Analysis; D004717:Endometrium / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics; D007436:Intrauterine Devices, Medicated / Q000191:economics; D016912:Levonorgestrel / Q000008:administration & dosage; D008390:Markov Chains; D008595:Menorrhagia / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D019057:Quality-Adjusted Life Years
D016912:Levonorgestrel