Hysterectomy: The most cost-effective solution for heavy menses

Using available evidence on effectiveness, cost, and utility values, hysterectomy is a more cost-effective solution for heavy menstrual bleeding than first- or second-generation endometrial ablation techniques or the levonorgestrel-releasing intrauterine system (Mirena; Bayer Healthcare, Morristown, New Jersey), according to the results of a recent analysis from the United Kingdom.

The researchers found that although hysterectomy is more expensive than the other 3 options tested, it produces more quality adjusted life years (QALYs) than the other strategies and is, therefore, more likely to be considered cost-effective. They calculated the incremental cost-effectiveness ratio for hysterectomy compared with Mirena to be $2,350 per additional QALY and the incremental cost-effectiveness ratio for hysterectomy compared with second-generation ablation to be $1,603. Second-generation ablation techniques and Mirena are less expensive, less invasive, and produce more QALYs than first-generation ablation techniques.

Although the results are consistent with those of other studies, the authors caution that they are highly sensitive to the utility values used. They also report that their results somewhat conflict with what is actually going on in clinical practice, which is that a reduction in the use of hysterectomy for heavy menstrual bleeding has occurred over the past decade, with women and their physicians favoring second-generation ablation techniques and Mirena.

Roberts TE, Tsourapas A, Middleton LJ, et al. Hysterectomy, endometrial ablation, and levonorgestrel releasing intrauterine system (Mirena) for treatment of heavy menstrual bleeding: cost effectiveness analysis. BMJ. 2011;342:d2202.