Cost-effectiveness of treatments for dysfunctional uterine bleeding in women who need contraception.
OBJECTIVE
This study aims to compare the cost-effectiveness of oral contraceptives (OCs), the levonorgestrel-releasing intrauterine system (LNG-IUS) and surgical management in treating dysfunctional uterine bleeding (DUB) in women not desiring additional children.


METHODS
A Markov model was constructed from the perspective of the health services payers for a 5-year period. Treatment costs, DUB treatment success rates and contraception success rates were obtained through a literature review.


RESULTS
In women not responding to an initial trial of OCs, surgical management was more effective than the LNG-IUS (95.5% vs. 92%) but at higher cost (US$4853 vs. US$2796 per woman). Among responders to OCs, continuing treatment with the LNG-IUS instead of OCs was more effective (92% vs. 90.4%) and less expensive (US$2796 vs. US$4711). For women naïve to medical therapy, the LNG-IUS and OCs had similar effectiveness, but cost for the LNG-IUS was lower (US$2796 vs. US$4895). In all scenarios, surgery followed if medical therapy failed; rates of primary method failure were 62.5% with OCs and 34% with the LNG-IUS at 12 months.


CONCLUSIONS
Treatment strategies employing the LNG-IUS are the most cost-effective in managing DUB, regardless of whether a woman has previously tried OC therapy.
Blumenthal
Paul D
PD
Department of Gynecology and Obstetrics, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
Trussell
James
J
Singh
Rameet H
RH
Guo
Amy
A
Borenstein
Jeffrey
J
Dubois
Robert W
RW
Liu
Zhimei
Z
D003267:Contraception; D003276:Contraceptives, Oral / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D016912:Levonorgestrel / Q000008:administration & dosage / Q000191:economics; D016239:MEDLINE; D008390:Markov Chains; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000188:drug therapy* / Q000601:surgery
D003276:Contraceptives, Oral; D016912:Levonorgestrel