Economic evaluation of the levonorgestrel-releasing intrauterine system for the treatment of dysfunctional uterine bleeding in Spain.
OBJECTIVE
To compare the cost and effectiveness of the levonorgestrel-releasing intrauterine system (LNG-IUS) versus combined oral contraception (COC) and progestogens (PROG) in first-line treatment of dysfunctional uterine bleeding (DUB) in Spain.


METHODS
A cost-effectiveness and cost-utility analysis of LNG-IUS, COC and PROG was carried out using a Markov model based on clinical data from the literature and expert opinion. The population studied were women with a previous diagnosis of idiopathic heavy menstrual bleeding. The analysis was performed from the National Health System perspective, discounting both costs and future effects at 3%. In addition, a sensitivity analysis (univariate and probabilistic) was conducted.


RESULTS
The results show that the greater efficacy of LNG-IUS translates into a gain of 1.92 and 3.89 symptom-free months (SFM) after six months of treatment versus COC and PROG, respectively (which represents an increase of 33% and 60% of symptom-free time). Regarding costs, LNG-IUS produces savings of € 174.2-309.95 and € 230.54-577.61 versus COC and PROG, respectively, after 6 months-5 years. Apart from cost savings and gains in SFM, quality-adjusted life months (QALM) are also favourable to LNG-IUS in all scenarios, with a range of gains between 1 and 2 QALM compared to COC and PROG.


CONCLUSIONS
The results indicate that first-line use of the LNG-IUS is the dominant therapeutic option (less costly and more effective) in comparison with first-line use of COC or PROG for the treatment of DUB in Spain. LNG-IUS as first line is also the option that provides greatest health-related quality of life to patients.
Gynaecology Department, Hospital Santiago Apóstol of Vitoria, Spain. ilete@hsan.OSAKIDETZA.net
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D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000191:economics*; D003277:Contraceptives, Oral, Combined / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000191:economics*; D016912:Levonorgestrel / Q000008:administration & dosage* / Q000191:economics; D008796:Metrorrhagia / Q000188:drug therapy*; D008962:Models, Theoretical; D011372:Progestins / Q000191:economics* / Q000627:therapeutic use; D011788:Quality of Life; D013030:Spain
D003271:Contraceptive Agents, Female; D003277:Contraceptives, Oral, Combined; D011372:Progestins; D016912:Levonorgestrel