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.
Centre for Pharmacoeconomics Research, School of Pharmacy, The Chinese University of Hong Kong, China. joyceyou@cuhk.edu.hk
Joyce H S
JH
You
Daljit Singh
DS
Sahota
Pong
P
MoYuen
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