Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada.
Gynecol Oncol. 2021 May;161(2):367-373. doi: 10.1016/j.ygyno.2021.02.020. Epub 2021 Feb 27.
To estimate the cost-effectiveness of the levonorgestrel intrauterine system (LNG-IUS) as an endometrial cancer prevention strategy in women with obesity.
A Markov decision-analytic model was used to compare 5 strategies in women with a body mass index of 30 or greater: 1) Usual care 2) LNG-IUS for 5 years 3) LNG-IUS for 7 years 4) LNG-IUS for 5 years, replaced once for a total of 10 years 5) LNG-IUS for 7 years, replaced once for a total of 14 years. Obesity was presumed to be associated with a 3-fold relative risk of endometrial cancer incidence and a 2.65-fold disease-specific mortality. The LNG-IUS was assumed to confer a 50% reduction in cancer incidence over the period of the LNG-IUS insertion. Outcomes were incremental cost-effectiveness ratios, calculated in 2019 Canadian dollars (CAD) per year of life saved. One-way and two-way sensitivity analyses were performed.
The LNG-IUS strategy was considered cost-effective if the cost of the intervention is less than $66,400 CAD ($50,000 US dollars) per year of life saved. The strategy becomes cost-effective if the LNG-IUS is inserted at age 57 (strategy #2), at age 52 for strategy #3, at age 51 for strategy #4 and at age 45 for strategy #5, when compared to usual care. The results are stable to variations in cost but sensitive to the estimated risk reduction of the LNG-IUS and the impact of obesity on endometrial cancer incidence and disease-specific mortality.
The LNG-IUS is a cost-effective method of endometrial cancer prevention in women with obesity.
评估左炔诺孕酮宫内节育系统（LNG-IUS）作为肥胖女性子宫内膜癌预防策略的成本效益。
采用马尔可夫决策分析模型，比较了体重指数（BMI）大于或等于 30 的 5 种策略：1）常规护理；2）LNG-IUS 治疗 5 年；3）LNG-IUS 治疗 7 年；4）LNG-IUS 治疗 5 年，总共更换 10 年；5）LNG-IUS 治疗 7 年，总共更换 14 年。假设肥胖与子宫内膜癌发病率的相对风险增加 3 倍，疾病特异性死亡率增加 2.65 倍。假设 LNG-IUS 可在 LNG-IUS 插入期间降低 50%的癌症发病率。结果为每年每增加 1 例生命的增量成本效益比，以 2019 年加拿大元（CAD）计算。进行了单因素和双因素敏感性分析。
如果干预的成本低于每年每增加 1 例生命的 CAD66,400 元（50,000 美元），则 LNG-IUS 策略被认为是具有成本效益的。与常规护理相比，当 LNG-IUS 于 57 岁（策略 #2）、52 岁（策略 #3）、51 岁（策略 #4）和 45 岁（策略 #5）插入时，该策略具有成本效益。结果对成本变化具有稳定性，但对 LNG-IUS 估计风险降低和肥胖对子宫内膜癌发病率和疾病特异性死亡率的影响敏感。
LNG-IUS 是肥胖女性子宫内膜癌预防的一种具有成本效益的方法。
