Resource use and costs associated with treatment of idiopathic menorrhagia with intrauterine system releasing levonorgestrel (LNG-IUS) versus hysterectomy: the perspective of the health care system (SUS)

Abstract

Introduction: Patients with heavy menstrual bleeding (HMB) failing to pharmacological treatment in Brazil become eligible for surgical treatments, since the LNG-IUS is unavailable in the public healthcare system (SUS). Objective: To describe the costs associated to HMB control with the LNG-IUS or hysterectomy under the SUS perspective in a one-year time horizon. Methods: Resources used were collected based on an observational retrospective study. The bottom-up approach method was used to estimate direct medical costs, based on the individual number of medical procedures and resources consumed by each patient multiplied by their respective unit costs. The following costs were included in the analysis. LNG-IUS group: LNG-IUS placement and replacement (if needed), complications and resources used after LNG-IUS placement, including medical visits, exams and subsequent therapies. Hysterectomy group: pre-operative costs, surgery, complications and follow-up costs, including medical visits and exams performed after the hysterectomy.Results: Among the women treated with LNG-IUS, 85.5% still used the device at one year and 83.1% had success in bleeding control. Costs for the LNG-IUS and hysterectomy groups in a one-year time horizon were R$824.65 and R$870.03, respectively. When applied to the eligible population in the SUS (32,605 patients), the estimated budget impact of LNG-IUS introduction would result in an economy of approximately R$1.5 million. Conclusions: Both treatments were effective in HMB control. The LNG-IUS may represent a good strategy for reducing the number of hysterectomies and costs associated to the treatment of HMB in the Brazilian public healthcare system.