Summary
Objective To investigate the costs of therapy with Mirena, a Levonorgesterol releasing intrauterine device, compared with endometrial ablation and hysterectomy in the management of menorrhagia.
Design Cost analysis was based on a simulation model of patient histories in three different age groups. Costs were derived from the accounting of an NHS hospital, and from NHS tariffs for inpatient and outpatient care. Efficacy, duration of surgery, and length of hospitalization were derived from the literature.
Setting Italian inpatient and outpatient clinics.
Patients and participants Women aged 40, 45 and 50 years were assessed.
Interventions 1) Mirena, an intrauterine contraceptive device releasing the progestinic hormone Levonorgesterol, 2) Hysterectomy, 3) Endometrial ablation.
Main outcome measures and results The use of Mirena was associated to a saving per person of 1.841.000 Lire and 3.591.000 Lire in 40 year-old and 50 year-old patients, respectively, when compared to hysterectomy. A saving of 694.000 Lire and 1.962.000 Lire per person were observed with Mirena therapy, in the 40 year-old and 50 year-old cohort, respectively, when compared to endometrial ablation.
The results appear robust as sensitivity confirms that the therapy with Mirena costs less than the surgery alternatives.
Conclusion When appropriate, therapy with Mirena appears rational from an economic point of view. According to the results of the simulation performed in the study, Mirena therapy will likely reduce Italian NHS costs in the management of menorrhagia.
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Fattore, G., Lazzaro, C. Analisi dei costi del trattamento della menorragia: un confronto tra isterectomia, ablazione endometriale e un sistema intrauterino di rilascio di levonorgestrel (Mirena). Pharmacoeconomics-Ital-Res-Articles 1, 1–15 (1999). https://doi.org/10.1007/BF03320515
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DOI: https://doi.org/10.1007/BF03320515