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Comparison of Levonorgestrel-releasing Intrauterine System (LNG-IUS) against Laparoscopic Assisted Supracervical Hysterectomy (LASH) for menorrhagia treatment: an economic evaluation
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  • Matthew Laughton,
  • Natasha Patel,
  • Fatema Dawoodbhoy,
  • Salma El-ghrably,
  • James Frater,
  • Saheel Mahmud
Matthew Laughton
Imperial College London Faculty of Medicine - South Kensington Campus
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Natasha Patel
Imperial College London Faculty of Medicine - South Kensington Campus
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Fatema Dawoodbhoy
Imperial College London Faculty of Medicine - South Kensington Campus
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Salma El-ghrably
Imperial College London Faculty of Medicine - South Kensington Campus
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James Frater
Imperial College London Faculty of Medicine - South Kensington Campus
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Saheel Mahmud
Imperial College London Faculty of Medicine - South Kensington Campus
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Abstract

Objective: To compare the cost-effectiveness of laparoscopic assisted supracervical hysterectomy (LASH) with NICE’s gold-standard treatment of Levonorgestrel-releasing intrauterine system (LNG-IUS) for menorrhagia treatment. Design: Economic evaluation. Setting: European studies. Population: Women under 50 referred for surgical menorrhagia treatment and eligible for endometrial ablation. Methods: A cost-utility analysis was conducted from an NHS perspective using data from existing literature to compare the treatments. Individual costs and benefits were assessed within one year of having interventions. An Incremental Cost-Effectiveness Ratio (ICER) was calculated, followed by sensitivity analysis. Main Outcome Measures: Expected Quality Adjusted Life Years (QALYS) and costs to the NHS were calculated alongside health net benefits (HNB) and monetary net benefits (MNB). Results: An ICER of 0.7 was used to calculate a MNB between -£14.99 and -£714.99, coupled with a HNB between –0.0357 QALYs and –0.0005 QALYS. LNG-IUS was more cost-effective than LASH, with LASH exceeding the upper bound of the £30,000/QALY limit used by NICE. Sensitivity analysis lowered the ICER below the given threshold. Conclusions: The ICER demonstrates it would not be cost-effective to replace the current gold-standard LNG-IUS with LASH, when treating menorrhagia in the UK. The ICER’s proximity to the threshold and its high sensitivity alludes to the necessity for further research to generate a more reliable cost-effectiveness estimate. Funding: None. Keywords: Economic evaluation, Cost-utility analysis, Incremental cost-effectiveness ratio (ICER), Levonorgestrel-releasing intrauterine system (LNG-IUS), Laparoscopic assisted supracervical hysterectomy (LASH), Menorrhagia. Tweetable abstract: LNG-IUS is marginally more cost-effective than LASH as a gold standard treatment for menorrhagia.