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Hum. Reprod. Advance Access originally published online on April 3, 2006
Human Reproduction 2006 21(7):1878-1883; doi:10.1093/humrep/del088
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

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

Joyce H.S. You 1 , 3 , Daljit Singh Sahota 2 and Pong MoYuen 2

1 Centre for Pharmacoeconomics Research, School of Pharmacy 2 Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China

3 To whom correspondence should be addressed at: Centre for Pharmacoeconomics Research, School of Pharmacy, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China. E-mail: joyceyou{at}cuhk.edu.hk

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: Hysterectomy appears to be cost effective, with ICER less than USD50 000, for management of menorrhagia.

Key words: cost-utility analysis/endometrial resection and ablation/hysterectomy/medical therapy/menorrhagia


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