Presentation (CTI)

OBJECTIVES: To evaluate utilization trends, costs, and clinical profiles of hysterectomies compared with the use of levonorgestrel-releasing hormonal intrauterine devices (L-IUD 52 mg) among women with Abnormal Uterine Bleeding (AUB) in the Brazilian private healthcare system.
METHODS: Retrospective cohort including beneficiaries aged 40-50 years who underwent hysterectomy or insertion of a 52 mg L-IUD for AUB treatment between 2020 and October 2025. Administrative data were extracted from a large Brazilian Health Insurance Company (Unimed Campinas). Hysterectomy costs were analyzed according to surgical type. Budget impact models assessed scenarios of 30% and 50% reductions in hysterectomies when L-IUDs are used as the initial intervention.
RESULTS: The cohort included 260,950 women, with 3,479 hysterectomies (1.3%) and 6,489 L-IUD insertions (2.5%). Among L-IUD users, 77% had insertions performed in outpatient settings. Insertions increased through 2024 (108%), while hysterectomies increased by 50.7% during the period. The main diagnoses associated with hysterectomies were leiomyoma, endometriosis, and excessive menstruation. Average costs ranged from US$ 792,9 (partial open) to US$ 1.597,9 (partial laparoscopy). Cumulative spending was US$ 4.3 million on hysterectomies and US$ 1.5 million on L-IUDs. Only 6% of women undergoing hysterectomy had previously used an L-IUD, suggesting underutilization as a conservative therapy. In scenarios of 30%-50% reduction in surgeries through broader adoption of L-IUD, projected savings ranged from US$ 1 million to US$ 1.7 million over five years.
CONCLUSIONS: The L-IUD represents a less invasive, cost-effective therapeutic alternative with substantial potential to prevent high-cost surgical procedures. Expanding its use as a first-line therapy for AUB may support resource optimization and better alignment with value-based care models.