title: Cost-effectiveness analysis in the treatment of heavy menstrual bleeding in Spain.
abstract: OBJECTIVE
  To compare the effectiveness and costs associated with first-line medical treatments for chronic heavy menstrual bleeding (HMB) in Spain.
  
  
  METHODS
  A cost-effectiveness analysis was conducted comparing the levonorgestrel-releasing intrauterine system (LNG-IUS) with the estradiol valerate/dienogest multiphase oral contraceptive (E2V/DNG), combined oral contraceptives (COC) and progestins (PROG). Study patients were fertile women diagnosed with HMB who initially wished to remain fertile. A Markov model based on reported clinical data and the opinion of a panel of experts was used. The time horizon of the analysis was 5 years. The analysis was conducted from the perspective of the Spanish National Health System (NHS), discounting both costs (€ 2013) and future effects at an annual rate of 3%. One-way sensitivity analyses and probabilistic sensitivity analysis were performed to test the robustness of the results.
  
  
  RESULTS
  In the analysis at 5 years, the LNG-IUS was associated with a gain of 0.67, 2.22, and 3.53 symptoms free months (SFM) compared with E2V/DNG, COC and PROG, respectively. LNG-IUS contributed more quality-adjusted life months (QALM) than the other treatment alternatives (+1.74 vs. E2V/DNG, +3.33 vs. COC +3.53 vs. PROG). First-line LNG-IUS treatment resulted in savings of € 583, € 988, and € 1891 vs. E2V/DNG, COC and PROG, respectively. These cost benefits, coupled with the greater clinical benefits in terms of SFM and QALM, show that LNG-IUS is the dominant option (less costly and more effective).
  
  
  CONCLUSIONS
  LNG-IUS is the medical treatment of choice and cost-saving option for the control of HMB in Spain.
authors.affiliation: Gynaecology and Obstetrics Department, Santa Creu i Sant Pau Hospital, Barcelona, Spain. Electronic address: jcalaf@hsp.santpau.es.
authors.forename: J
authors.initials: J
authors.lastname: Calaf
authors.affiliation: Gynaecology Department, University Hospital of Araba, Vitoria, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Lete
authors.affiliation: Medical Department, Bayer HealthCare, Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Canals
authors.affiliation: Department of Statistics, University of Barcelona, Barcelona, Spain; Oblikue Consulting, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Crespo
authors.affiliation: Market Access Department, Bayer HealthCare, Barcelona, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Espinós
authors.affiliation: Gynaecology and Obstetrics Department, Sanitas La Zarzuela Hospital, Madrid, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Cristóbal
mesh_terms: D003277:Contraceptives, Oral, Combined / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D004958:Estradiol / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000191:economics*; D016912:Levonorgestrel / Q000191:economics* / Q000627:therapeutic use; D008595:Menorrhagia / Q000188:drug therapy* / Q000191:economics; D008962:Models, Theoretical; D009277:Nandrolone / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D013030:Spain
chemical_list: D003277:Contraceptives, Oral, Combined; D004338:Drug Combinations; C454300:estradiol valerate-dienogest; D004958:Estradiol; D016912:Levonorgestrel; D009277:Nandrolone
keywords: Cost-effectiveness; Estradiol valerate/dienogest; Heavy menstrual bleeding; Levonorgestrel-releasing intrauterine system; Spain