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

Matthew Laughton, Natasha Chandrakant Patel, Natasha Patel, Fatema Mustansir Dawoodbhoy, Salma El-Ghrably, Saheel Mahmud
Journal of gynecology obstetrics and human reproduction · 2021 · vol. 50(10) , pp. 102229 · doi:10.1016/j.jogoh.2021.102229 · PMID:34520876 · W3200250479
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This economic evaluation compares the cost-effectiveness of the levonorgestrel-releasing intrauterine system (LNG-IUS) against laparoscopic-assisted supracervical hysterectomy (LASH) for treating menorrhagia.

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Abstract

BACKGROUND: This economic evaluation and literature review was conducted with the primary aim 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. MATERIALS AND METHODS: A cost-utility analysis was conducted from an NHS perspective, using data from two European studies to compare the treatments. Individual costs and benefits were assessed within one year of having the intervention. An Incremental Cost-Effectiveness Ratio (ICER) was calculated, followed by sensitivity analysis. Expected Quality Adjusted Life Years (QALYS) and costs to the NHS were calculated alongside health net benefits (HNB) and monetary net benefits (MNB). RESULTS: A QALY gain of 0.069 was seen in use of LNG-IUS compared to LASH. This yielded a MNB between -£44.99 and -£734.99, alongside a HNB between -0.0705 QALYs and -0.106 QALYS. Using a £20,000-£30,000/QALY limit outlined by NICE,this showed the LNG-IUS to be more cost-effective than LASH, with LASH exceeding the upper bound of the £30,000/QALY limit. 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. However, LASH could be considered as a first line treatment option in women with no desire to have children.

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MeSH descriptors

Hysterectomy Intrauterine Devices Levonorgestrel Menorrhagia Cost-Benefit Analysis Cost-Benefit Analysis Cost-Benefit Analysis Female Humans Hysterectomy Hysterectomy Hysterectomy Intrauterine Devices Intrauterine Devices Laparoscopy Laparoscopy Laparoscopy Laparoscopy Levonorgestrel Levonorgestrel

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