Levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: an economic evaluation alongside a randomised controlled trial
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 alternativ...
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| Format: | Article |
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Public Library of Science
2014
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| Online Access: | https://eprints.nottingham.ac.uk/47623/ |
| _version_ | 1848797591436787712 |
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| author | Sanghera, Sabina Roberts, Tracy Elizabeth Barton, Pelham Frew, Emma Daniels, Jane Middleton, Lee Gennard, Laura Kai, Joe Gupta, Janesh Kumar |
| author_facet | Sanghera, Sabina Roberts, Tracy Elizabeth Barton, Pelham Frew, Emma Daniels, Jane Middleton, Lee Gennard, Laura Kai, Joe Gupta, Janesh Kumar |
| author_sort | Sanghera, Sabina |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | 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. |
| first_indexed | 2025-11-14T20:06:19Z |
| format | Article |
| id | nottingham-47623 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T20:06:19Z |
| publishDate | 2014 |
| publisher | Public Library of Science |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-476232020-05-04T16:44:43Z https://eprints.nottingham.ac.uk/47623/ 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 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. Public Library of Science 2014-03-17 Article PeerReviewed Sanghera, Sabina, Roberts, Tracy Elizabeth, Barton, Pelham, Frew, Emma, Daniels, Jane, Middleton, Lee, Gennard, Laura, Kai, Joe and Gupta, Janesh Kumar (2014) Levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: an economic evaluation alongside a randomised controlled trial. PLoS ONE, 9 (3). e91891/1-e91891/11. ISSN 1932-6203 Levonorgestrel-Releasing Intrauterine System; Menorrhagia; Economic Evaluation; Randomised Controlled Trial; Primary Care http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0091891 doi:10.1371/journal.pone.0091891 doi:10.1371/journal.pone.0091891 |
| spellingShingle | Levonorgestrel-Releasing Intrauterine System; Menorrhagia; Economic Evaluation; Randomised Controlled Trial; Primary Care Sanghera, Sabina Roberts, Tracy Elizabeth Barton, Pelham Frew, Emma Daniels, Jane Middleton, Lee Gennard, Laura Kai, Joe Gupta, Janesh Kumar Levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: an economic evaluation alongside a randomised controlled trial |
| title | Levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: an economic evaluation alongside a randomised controlled trial |
| title_full | Levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: an economic evaluation alongside a randomised controlled trial |
| title_fullStr | Levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: an economic evaluation alongside a randomised controlled trial |
| title_full_unstemmed | Levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: an economic evaluation alongside a randomised controlled trial |
| title_short | Levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: an economic evaluation alongside a randomised controlled trial |
| title_sort | levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: an economic evaluation alongside a randomised controlled trial |
| topic | Levonorgestrel-Releasing Intrauterine System; Menorrhagia; Economic Evaluation; Randomised Controlled Trial; Primary Care |
| url | https://eprints.nottingham.ac.uk/47623/ https://eprints.nottingham.ac.uk/47623/ https://eprints.nottingham.ac.uk/47623/ |