title: The cost-effectiveness of the levonorgestrel-releasing intrauterine system for the treatment of idiopathic heavy menstrual bleeding in the United States.
abstract: OBJECTIVE
  Heavy menstrual bleeding negatively impacts the health and quality of life of about 18 million women in the United States. Although some studies have established the clinical effectiveness of heavy menstrual bleeding treatments, few have evaluated their cost-effectiveness. Our objective was to evaluate the cost-effectiveness of the levonorgestrel-releasing intrauterine system (LNG-IUS) compared with other therapies for idiopathic heavy menstrual bleeding.
  
  
  METHODS
  We developed a model comparing the clinical and economic outcomes (from a US payer perspective) of three broad initial treatment strategies over 5 years: LNG-IUS, oral agents, or surgery. Up to three nonsurgical treatment lines, followed by up to two surgical lines, were allowed; unintended pregnancy was possible, and women could discontinue any time during nonsurgical treatments. Menstrual blood loss of 80 ml or more per cycle determined treatment failure.
  
  
  RESULTS
  Initiating treatment with LNG-IUS resulted in the fewest hysterectomies (6 per 1000 women), the most quality-adjusted life-years (3.78), and the lowest costs ($1137) among all the nonsurgical strategies. Initiating treatment with LNG-IUS was also less costly than surgery, resulted in fewer hysterectomies (vs. 9 per 1000 for ablation) but was associated with fewer quality-adjusted life-years gained per patient (vs. 3.80 and 3.88 for ablation and hysterectomy, respectively). Sensitivity analyses confirmed these results.
  
  
  CONCLUSIONS
  LNG-IUS resulted in the lowest treatment costs and the fewest number of hysterectomies performed over 5 years compared with all other initial strategies and resulted in the most quality-adjusted life-years gained among nonsurgical options. Initial treatment with LNG-IUS is the least costly and most effective option for women desiring to preserve their fertility.
authors.affiliation: United BioSource Corporation, Lexington, MA 02420, USA. michael.ganz@unitedbiosource.com
authors.forename: Michael L
authors.initials: ML
authors.lastname: Ganz
authors.forename: Dhvani
authors.initials: D
authors.lastname: Shah
authors.forename: Risha
authors.initials: R
authors.lastname: Gidwani
authors.forename: Anna
authors.initials: A
authors.lastname: Filonenko
authors.forename: Wenqing
authors.initials: W
authors.lastname: Su
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pocoski
authors.forename: Amy
authors.initials: A
authors.lastname: Law
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data; D007436:Intrauterine Devices, Medicated / Q000191:economics*; D016912:Levonorgestrel / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D008595:Menorrhagia / Q000188:drug therapy / Q000191:economics* / Q000601:surgery; D018803:Models, Economic; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D014481:United States
chemical_list: D016912:Levonorgestrel