Comparison of Levonorgestrel-releasing Intrauterine System (LNG-IUS)
against Laparoscopic Assisted Supracervical Hysterectomy (LASH) for
menorrhagia treatment: an economic evaluation
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.