A Cost-Effectiveness Analysis of Intrauterine Spacers Used to Prevent the Formation of Intrauterine Adhesions Following Endometrial Cavity Surgery

OBJECTIVES: To assess, from a United States (US) payer’s perspective, the cost-effectiveness of devices designed to separate the endometrial surfaces (intrauterine spacers) placed immediately following intrauterine surgery to prevent adhesions.

METHODS: A decision tree model was developed to estimate the cost-effectiveness of intrauterine spacers used to facilitate endometrial repair and prevent the formation (primary prevention) and reformation (secondary prevention) of intrauterine adhesions (IUAs) and associated pregnancy- and birth-related adverse outcomes. Event rates and costs were extrapolated from data available in the existing literature. Sensitivity analyses were conducted to corroborate the base case results.

RESULTS: In this model, using intrauterine spacer devices for adhesion prevention led to net cost savings for US payers of $2,905 per patient over a 3.5-year time horizon. These savings were driven by the direct benefit of preventing procedures associated with IUA formation ($2,162 net savings) and the indirect benefit of preventing pregnancy-related complications often associated with IUA formation ($3,002). These factors offset the incremental cost of intrauterine spacer device use of $1,539 based on an assumed price of $1,800 and the related increase in normal deliveries of $931. Model outcomes were sensitive to the probability of preterm and normal deliveries. Budget impact analyses show overall cost savings of $19.96 per initial member within a US healthcare plan, translating to $20 million over a 5-year time horizon for a one-million-member plan.

CONCLUSIONS: This analysis robustly demonstrated that intrauterine spacer devices would be cost-saving to healthcare payers, including both per-patient and per-plan member, through a reduction in IUAs and improvements to patients’ pregnancy-related outcomes.