左炔诺孕酮宫内缓释系统（LNG-IUS）与腹腔镜辅助经宫颈子宫切除术（LASH）治疗月经过多的比较：一项经济学评价。

Comparison of Levonorgestrel-releasing Intrauterine System (LNG-IUS) against Laparoscopic Assisted Supracervical Hysterectomy (LASH) for menorrhagia treatment: An economic evaluation.

机构信息

University of Southampton Faculty of Medicine, Faculty of Medicine Southampton, Southampton, United Kingdom; Imperial College Business School, South Kensington Campus, Exhibition Rd, London.

Imperial College Business School, South Kensington Campus, Exhibition Rd, London; Faculty of Medicine, Imperial College London, London, United Kingdom.

出版信息

J Gynecol Obstet Hum Reprod. 2021 Dec;50(10):102229. doi: 10.1016/j.jogoh.2021.102229. Epub 2021 Sep 11.

DOI:10.1016/j.jogoh.2021.102229

PMID:34520876

Abstract

BACKGROUND

This economic evaluation and literature review was conducted with the primary aim to compare the cost-effectiveness of laparoscopic assisted supracervical hysterectomy (LASH) with NICE's gold-standard treatment of Levonorgestrel-releasing intrauterine system (LNG-IUS) for menorrhagia.

MATERIALS AND METHODS

A cost-utility analysis was conducted from an NHS perspective, using data from two European studies to compare the treatments. Individual costs and benefits were assessed within one year of having the intervention. An Incremental Cost-Effectiveness Ratio (ICER) was calculated, followed by sensitivity analysis. Expected Quality Adjusted Life Years (QALYS) and costs to the NHS were calculated alongside health net benefits (HNB) and monetary net benefits (MNB).

RESULTS

A QALY gain of 0.069 was seen in use of LNG-IUS compared to LASH. This yielded a MNB between -£44.99 and -£734.99, alongside a HNB between -0.0705 QALYs and -0.106 QALYS. Using a £20,000-£30,000/QALY limit outlined by NICE,this showed the LNG-IUS to be more cost-effective than LASH, with LASH exceeding the upper bound of the £30,000/QALY limit. Sensitivity analysis lowered the ICER below the given threshold.

CONCLUSIONS

The ICER demonstrates it would not be cost-effective to replace the current gold-standard LNG-IUS with LASH, when treating menorrhagia in the UK. The ICER's proximity to the threshold and its high sensitivity alludes to the necessity for further research to generate a more reliable cost-effectiveness estimate. However, LASH could be considered as a first line treatment option in women with no desire to have children.

摘要

背景

本项经济评价和文献回顾旨在比较经阴道腹腔镜辅助子宫切除术（LASH）与 NICE 治疗月经过多的金标准左炔诺孕酮宫内缓释系统（LNG-IUS）的成本效益。

材料和方法

从英国国家医疗服务体系（NHS）的角度进行了成本效用分析，使用来自两项欧洲研究的数据来比较两种治疗方法。在干预后一年的时间内评估了个体成本和效益。计算了增量成本效益比（ICER），并进行了敏感性分析。同时计算了 NHS 的预期质量调整生命年（QALY）和成本，以及健康净收益（HNB）和货币净收益（MNB）。

结果

使用 LNG-IUS 治疗可使 QALY 增加 0.069，而 LASH 治疗则可使 QALY 增加 0.069。这使得 NHS 的 MNB 在-£44.99 至-£734.99 之间，HNB 在-0.0705 QALY 至-0.106 QALY 之间。使用 NICE 规定的 £20,000-£30,000/QALY 限制，LNG-IUS 比 LASH 更具成本效益，而 LASH 超过了 £30,000/QALY 的上限。敏感性分析将 ICER 降低到给定阈值以下。