A cost-utility analysis of hysterectomy, endometrial resection and ablation and medical therapy for menorrhagia.

Four types of treatment [hysterectomy, endometrial resection/ablation, levonorgestrel-releasing intrauterine system (LNG-IUS) and oral medical therapy] are available for management of menorrhagia. The objective of this study was to compare the cost and quality-adjusted life-years (QALYs) gained by these four treatment alternatives.
A Markov model was designed to simulate the healthcare resource utilization and QALYs of the four treatment alternatives for patients presenting with menorrhagia over 5 years. Clinical inputs were estimated from literature, and the cost analysis was conducted from the perspective of healthcare provider in Hong Kong.
The base-case analysis showed that the hysterectomy group was the most effective (4.725 QALYs) alternative with the highest cost (USD6878, 1USD=7.8HKD). The incremental cost per additional QALY (ICER) gained by hysterectomy was USD23 500. The probability of extra surgery in the endometrial resection/ablation was an influential factor. Probabalistic sensitivity analysis of 10,000 simulations of the Monte Carlo model showed that the hysterectomy group gained higher number of QALYs than the LNG-IUS, oral medical treatment and endometrial resection/ablation groups, 99, 99 and 98% of the time, and it was more costly than the other three groups over 85% of the time.
Hysterectomy appears to be cost effective, with ICER less than USD50,000, for management of menorrhagia.
AuthorsJoyce H S You, Daljit Singh Sahota, Pong MoYuen
JournalHuman reproduction (Oxford, England) (Hum Reprod) Vol. 21 Issue 7 Pg. 1878-83 (Jul 2006) ISSN: 0268-1161 [Print] England
PMID16585125 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Levonorgestrel
  • Adult
  • Cost-Benefit Analysis
  • Endometrium (surgery)
  • Female
  • Humans
  • Hysterectomy (economics)
  • Intrauterine Devices, Medicated (economics)
  • Levonorgestrel (administration & dosage)
  • Markov Chains
  • Menorrhagia (economics, surgery, therapy)
  • Quality-Adjusted Life Years

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