title: Cost-effectiveness of treatments for dysfunctional uterine bleeding in women who need contraception.
abstract: 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.
authors.affiliation: Department of Gynecology and Obstetrics, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Blumenthal
authors.forename: James
authors.initials: J
authors.lastname: Trussell
authors.forename: Rameet H
authors.initials: RH
authors.lastname: Singh
authors.forename: Amy
authors.initials: A
authors.lastname: Guo
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Borenstein
authors.forename: Robert W
authors.initials: RW
authors.lastname: Dubois
authors.forename: Zhimei
authors.initials: Z
authors.lastname: Liu
mesh_terms: 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
chemical_list: D003276:Contraceptives, Oral; D016912:Levonorgestrel