Cost-effectiveness of treatments for dysfunctional uterine bleeding.
OBJECTIVE
To compare the cost-effectiveness of treatments for dysfunctional uterine bleeding (DUB).


METHODS
The decision analytic model used a third-party payer perspective and 18-month horizon to compare treatment of DUB patients > or = 40 years old with no desire for fertility. Treatments were oral contraceptives (OCs) vs. surgery (first-/second-generation ablation or hysterectomy) after 3-9 months of OCs. Costs were based on publications and expert opinion. Efficacy measures were based on months with pictorial blood loss assessment chart (PBAC) score < 100 and number of months of amenorrhea.


RESULTS
Treatment costs were estimated at 513 dollars per patient per year (OCs), 3,500 dollars (first-generation ablation), 3,000 dollars (second-generation ablation) and 7,500 dollars (hysterectomy). Adverse event costs ranged from 12 dollars per year or episode (OCs, second-generation ablation) to 164 dollars per episode (hysterectomy). To achieve PBAC < 100, second-generation ablation after 3 months of OCs was the most cost-effective (7.6 additional DUB-free months vs. OCs, 215 dollars per additional month). Second-generation ablation was less costly and more effective than first-generation ablation. Early treatment with hysterectomy was more effective than ablation, but at substantial cost. When using the end point of amenorrhea, hysterectomy was most cost-effective. Results were not sensitive to variations in costs, effectiveness or length of OC use.


CONCLUSIONS
A short OC trial followed by second-generation ablation is the most cost-effective strategy for women with DUB, although hysterectomy is more cost-effective to achieve amenorrhea. Hysterectomy cost-effectiveness might improve if evaluated over more time. Cost-effectiveness and patient preference must all play a role in treatment decisions.
Wade
Sally W
SW
PHAR, LLC, Los Angeles, California, USA.
Magee
Glenn
G
Metz
Laurent
L
Broder
Michael S
MS
D000328:Adult; D017115:Catheter Ablation / Q000191:economics*; D003276:Contraceptives, Oral / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007044:Hysterectomy / Q000191:economics*; D008796:Metrorrhagia / Q000188:drug therapy / Q000191:economics* / Q000601:surgery; D008875:Middle Aged; D008962:Models, Theoretical
D003276:Contraceptives, Oral