Which Treatment Is Most Cost-Effective for Heavy Menstrual Bleeding?

Heavy menstrual bleeding can adversely affect health and quality of life. In a randomized controlled trial, initial treatment of heavy menstrual bleeding with the levonorgestrel-releasing intrauterine system (LNG-IUS) was more cost-effective than immediate hysterectomy, even though 40% of women in the LNG-IUS arm eventually underwent hysterectomies (JW Womens Health Jun 9 2004). Now, investigators have developed a Markov model to assess relative costs and effectiveness of initial treatment with the LNG-IUS, hysterectomy, or endometrial ablation.

Analysis based on the model showed that hysterectomy is the most cost-effective initial approach, when the assumption is made that all women who experience treatment failure after first-line use of t…