Hysterectomy, endometrial ablation, and levonorgestrel releasing intrauterine system (Mirena) for treatment of heavy menstrual bleeding: cost effectiveness analysis
T E Roberts, A Tsouparas, L J Middleton, R Champaneria, J P Daniels, K G Cooper, S Bhattacharya, P M Barton
Data Safe Haven
Objective To undertake a cost effectiveness analysis comparing first and second generation endometrial ablative techniques, hysterectomy, and the levonorgestrel releasing intrauterine system (Mirena) for treating heavy menstrual bleeding. Design Model based economic evaluation with data from an individual patient data meta-analysis supplemented with cost and outcome data from published sources taking an NHS (National Health Service) perspective. A state transition (Markov) model was developed, the
structure being informed by the reviews of the trials and clinical input. A subgroup analysis, one way sensitivity analysis, and probabilistic sensitivity analysis were also carried out. Population Four hypothetical cohorts of women with heavy menstrual bleeding.
Interventions One of four alternative strategies: Mirena, first or second generation endometrial ablation techniques, or hysterectomy.
Main outcome measures Cost effectiveness based on incremental cost per quality adjusted life year (QALY). Results Hysterectomy is the preferred strategy for the first intervention for heavy menstrual bleeding. Although hysterectomy is more expensive, it produces more QALYs relative to other remaining strategies and is likely to be considered cost effective. The incremental cost
effectiveness ratio for hysterectomy compared with Mirena is £1440 (€1633, $2350) per additional QALY. The incremental cost effectiveness ratio for hysterectomy compared with second generation ablation is £970 per additional QALY. Conclusion In light of the acceptable thresholds used by the National Institute for Health and Clinical Excellence, hysterectomy would be considered the preferred strategy for the treatment of heavy menstrual bleeding. The results concur with those of other studies but are highly sensitive to utility values used in the analysis.
https://doi.org/10.1136/bmj.d2202
Published - 26 Apr 2011
Endometrial Ablation Techniques
Quality-Adjusted Life Years
Information Storage and Retrieval
National Institutes of Health (U.S.)
Roberts, T. E., Tsouparas, A., Middleton, L. J., Champaneria, R., Daniels, J. P., Cooper, K. G., ... Barton, P. M. (2011). Hysterectomy, endometrial ablation, and levonorgestrel releasing intrauterine system (Mirena) for treatment of heavy menstrual bleeding: cost effectiveness analysis. British Medical Journal, 342(-), [d2202]. https://doi.org/10.1136/bmj.d2202
Hysterectomy, endometrial ablation, and levonorgestrel releasing intrauterine system (Mirena) for treatment of heavy menstrual bleeding : cost effectiveness analysis. / Roberts, T E; Tsouparas, A; Middleton, L J; Champaneria, R; Daniels, J P; Cooper, K G; Bhattacharya, S; Barton, P M.
In: British Medical Journal, Vol. 342, No. -, d2202, 26.04.2011.
Roberts, TE, Tsouparas, A, Middleton, LJ, Champaneria, R, Daniels, JP, Cooper, KG, Bhattacharya, S & Barton, PM 2011, 'Hysterectomy, endometrial ablation, and levonorgestrel releasing intrauterine system (Mirena) for treatment of heavy menstrual bleeding: cost effectiveness analysis', British Medical Journal, vol. 342, no. -, d2202. https://doi.org/10.1136/bmj.d2202
Roberts TE, Tsouparas A, Middleton LJ, Champaneria R, Daniels JP, Cooper KG et al. Hysterectomy, endometrial ablation, and levonorgestrel releasing intrauterine system (Mirena) for treatment of heavy menstrual bleeding: cost effectiveness analysis. British Medical Journal. 2011 Apr 26;342(-). d2202. https://doi.org/10.1136/bmj.d2202
Roberts, T E ; Tsouparas, A ; Middleton, L J ; Champaneria, R ; Daniels, J P ; Cooper, K G ; Bhattacharya, S ; Barton, P M. / Hysterectomy, endometrial ablation, and levonorgestrel releasing intrauterine system (Mirena) for treatment of heavy menstrual bleeding : cost effectiveness analysis. In: British Medical Journal. 2011 ; Vol. 342, No. -.
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title = "Hysterectomy, endometrial ablation, and levonorgestrel releasing intrauterine system (Mirena) for treatment of heavy menstrual bleeding: cost effectiveness analysis",
abstract = "Objective To undertake a cost effectiveness analysis comparing first and second generation endometrial ablative techniques, hysterectomy, and the levonorgestrel releasing intrauterine system (Mirena) for treating heavy menstrual bleeding. Design Model based economic evaluation with data from an individual patient data meta-analysis supplemented with cost and outcome data from published sources taking an NHS (National Health Service) perspective. A state transition (Markov) model was developed, the structure being informed by the reviews of the trials and clinical input. A subgroup analysis, one way sensitivity analysis, and probabilistic sensitivity analysis were also carried out. Population Four hypothetical cohorts of women with heavy menstrual bleeding. Interventions One of four alternative strategies: Mirena, first or second generation endometrial ablation techniques, or hysterectomy. Main outcome measures Cost effectiveness based on incremental cost per quality adjusted life year (QALY). Results Hysterectomy is the preferred strategy for the first intervention for heavy menstrual bleeding. Although hysterectomy is more expensive, it produces more QALYs relative to other remaining strategies and is likely to be considered cost effective. The incremental cost effectiveness ratio for hysterectomy compared with Mirena is £1440 (€1633, $2350) per additional QALY. The incremental cost effectiveness ratio for hysterectomy compared with second generation ablation is £970 per additional QALY. Conclusion In light of the acceptable thresholds used by the National Institute for Health and Clinical Excellence, hysterectomy would be considered the preferred strategy for the treatment of heavy menstrual bleeding. The results concur with those of other studies but are highly sensitive to utility values used in the analysis.",
author = "Roberts, {T E} and A Tsouparas and Middleton, {L J} and R Champaneria and Daniels, {J P} and Cooper, {K G} and S Bhattacharya and Barton, {P M}",
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T1 - Hysterectomy, endometrial ablation, and levonorgestrel releasing intrauterine system (Mirena) for treatment of heavy menstrual bleeding
T2 - cost effectiveness analysis
AU - Roberts, T E
AU - Tsouparas, A
AU - Middleton, L J
AU - Champaneria, R
AU - Daniels, J P
AU - Cooper, K G
AU - Bhattacharya, S
AU - Barton, P M
N2 - Objective To undertake a cost effectiveness analysis comparing first and second generation endometrial ablative techniques, hysterectomy, and the levonorgestrel releasing intrauterine system (Mirena) for treating heavy menstrual bleeding. Design Model based economic evaluation with data from an individual patient data meta-analysis supplemented with cost and outcome data from published sources taking an NHS (National Health Service) perspective. A state transition (Markov) model was developed, the structure being informed by the reviews of the trials and clinical input. A subgroup analysis, one way sensitivity analysis, and probabilistic sensitivity analysis were also carried out. Population Four hypothetical cohorts of women with heavy menstrual bleeding. Interventions One of four alternative strategies: Mirena, first or second generation endometrial ablation techniques, or hysterectomy. Main outcome measures Cost effectiveness based on incremental cost per quality adjusted life year (QALY). Results Hysterectomy is the preferred strategy for the first intervention for heavy menstrual bleeding. Although hysterectomy is more expensive, it produces more QALYs relative to other remaining strategies and is likely to be considered cost effective. The incremental cost effectiveness ratio for hysterectomy compared with Mirena is £1440 (€1633, $2350) per additional QALY. The incremental cost effectiveness ratio for hysterectomy compared with second generation ablation is £970 per additional QALY. Conclusion In light of the acceptable thresholds used by the National Institute for Health and Clinical Excellence, hysterectomy would be considered the preferred strategy for the treatment of heavy menstrual bleeding. The results concur with those of other studies but are highly sensitive to utility values used in the analysis.
AB - Objective To undertake a cost effectiveness analysis comparing first and second generation endometrial ablative techniques, hysterectomy, and the levonorgestrel releasing intrauterine system (Mirena) for treating heavy menstrual bleeding. Design Model based economic evaluation with data from an individual patient data meta-analysis supplemented with cost and outcome data from published sources taking an NHS (National Health Service) perspective. A state transition (Markov) model was developed, the structure being informed by the reviews of the trials and clinical input. A subgroup analysis, one way sensitivity analysis, and probabilistic sensitivity analysis were also carried out. Population Four hypothetical cohorts of women with heavy menstrual bleeding. Interventions One of four alternative strategies: Mirena, first or second generation endometrial ablation techniques, or hysterectomy. Main outcome measures Cost effectiveness based on incremental cost per quality adjusted life year (QALY). Results Hysterectomy is the preferred strategy for the first intervention for heavy menstrual bleeding. Although hysterectomy is more expensive, it produces more QALYs relative to other remaining strategies and is likely to be considered cost effective. The incremental cost effectiveness ratio for hysterectomy compared with Mirena is £1440 (€1633, $2350) per additional QALY. The incremental cost effectiveness ratio for hysterectomy compared with second generation ablation is £970 per additional QALY. Conclusion In light of the acceptable thresholds used by the National Institute for Health and Clinical Excellence, hysterectomy would be considered the preferred strategy for the treatment of heavy menstrual bleeding. The results concur with those of other studies but are highly sensitive to utility values used in the analysis.
U2 - 10.1136/bmj.d2202
DO - 10.1136/bmj.d2202
JO - BMJ
JF - BMJ
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M1 - d2202
10.1136/bmj.d2202
Hysterectomy EA and levonorgesetrel releasing IU system Mirena for treatment of HMB cost effective analysis
© 2011 BMJ Publishing Group Ltd Can be found online here : BMJ 2011; 342 doi: 10.1136/bmj.d2202
Final published version, 151 KB