Cost-effectiveness of two treatments for excessive menstrual bleeding in large uteri

Abstract

Introduction: Excessive menstrual bleeding is menstrual loss that interferes with the woman's quality of life, regardless of the absolute amount. Drug treatment is preferred to avoid surgical risks and preserve fertility. Anti-inflammatory, antifibrinolytic, oral contraceptive and progestogen are prescribed. These therapies result in 40 to 50% reduction in menstrual loss. The intrauterine levonorgestrel system (SIU-LNG) is the most effective long-term clinical treatment. On the other hand, hysterectomy is the most widely performed gynecological surgical procedure in the world and, although it offers complete control of symptoms, it is the most invasive, morbidly, irreversible and costly method of treatment. Objective: To compare the results and costs of clinical treatment with SIU-LNG and hysterectomy in women with large uteri and excessive menstrual bleeding. Method: It is a retrospective cohort study with 62 patients who performed two treatments: SIU-LNG insertion or videolaparoscopic hysterectomy (HVLP) and followed for four years. Results: The groups were homogeneous regarding age, parity, body mass index, schooling and uterine volume. SIU-LNG failed in 32.3% of patients, while the efficacy of hysterectomy was 100%. Complications occurred 22.6% after UIS insertion and 19.4% in the surgical group, the most serious. The cost of clinical treatment, including its complications, was nearly five times lower than the cost of surgical treatment with its complications. Conclusion: Compared to hysterectomy, treatment with SIU-LNG had lower efficacy, but simpler complications and lower costs.