Levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: an economic evaluation alongside a randomised controlled trial
Sanghera, Sabina; Roberts, Tracy Elizabeth; Barton, Pelham; Frew, Emma; Daniels, Jane; Middleton, Lee; Gennard, Laura; Kai, Joe; Gupta, Janesh Kumar
Tracy Elizabeth Roberts
Professor JANE DANIELS JANE.DANIELS@NOTTINGHAM.AC.UK
Professor of Clinical Trials
Professor JOE KAI firstname.lastname@example.org
Professor of Primary Care
Janesh Kumar Gupta
Objective: To undertake an economic evaluation alongside the largest randomised controlled trial comparing Levonorgestrel-releasing intrauterine device (‘LNG-IUS’) and usual medical treatment for women with menorrhagia in primary care; and compare the cost-effectiveness findings using two alternative measures of quality of life.
Methods: 571 women with menorrhagia from 63 UK centres were randomised between February 2005 and July 2009. Women were randomised to having a LNG-IUS fitted, or usual medical treatment, after discussing with their general practitioner their contraceptive needs or desire to avoid hormonal treatment. The treatment was specified prior to randomisation. For the economic evaluation we developed a state transition (Markov) model with a 24 month follow-up. The model structure was informed by the trial women's pathway and clinical experts. The economic evaluation adopted a UK National Health Service perspective and was based on an outcome of incremental cost per Quality Adjusted Life Year (QALY) estimated using both EQ-5D and SF-6D.
Results: Using EQ-5D, LNG-IUS was the most cost-effective treatment for menorrhagia. LNG-IUS costs £100 more than usual medical treatment but generated 0.07 more QALYs. The incremental cost-effectiveness ratio for LNG-IUS compared to usual medical treatment was £1600 per additional QALY. Using SF-6D, usual medical treatment was the most cost-effective treatment. Usual medical treatment was both less costly (£100) and generated 0.002 more QALYs.
Conclusion: Impact on quality of life is the primary indicator of treatment success in menorrhagia. However, the most cost-effective treatment differs depending on the quality of life measure used to estimate the QALY. Under UK guidelines LNG-IUS would be the recommended treatment for menorrhagia. This study demonstrates that the appropriate valuation of outcomes in menorrhagia is crucial.
Sanghera, S., Roberts, T. E., Barton, P., Frew, E., Daniels, J., Middleton, L., …Gupta, J. K. (2014). Levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: an economic evaluation alongside a randomised controlled trial. PLoS ONE, 9(3), https://doi.org/10.1371/journal.pone.0091891
|Journal Article Type||Article|
|Acceptance Date||Feb 17, 2014|
|Publication Date||Mar 17, 2014|
|Deposit Date||Oct 27, 2017|
|Publicly Available Date||Oct 27, 2017|
|Publisher||Public Library of Science|
|Peer Reviewed||Peer Reviewed|
|Keywords||Levonorgestrel-Releasing Intrauterine System; Menorrhagia; Economic Evaluation; Randomised Controlled Trial; Primary Care|
|Related Public URLs||https://creativecommons.org/licenses/by/4.0/|
|Copyright Statement||Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0|
|Additional Information||Sanghera S, Roberts TE, Barton P, Frew E, Daniels J, et al. (2014) Levonorgestrel-Releasing Intrauterine System vs. Usual Medical Treatment for Menorrhagia: An Economic Evaluation Alongside a Randomised Controlled Trial. PLoS ONE 9(3): e91891. doi:10.1371/journal.pone.0091891|
Sanghera PLoS One 2014.pdf
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0
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