Presentation (CTI)

OBJECTIVES: This study evaluated the clinical effectiveness and cost effectiveness of the levonorgestrel releasing intrauterine system (LNG-IUS) compared with alternative management strategies within the Indian public healthcare system.
METHODS: A systematic review of randomized and observational studies evaluated LNG-IUS for gynaecological indications. Study selection and data extraction were conducted using the Joanna Briggs Institute (JBI) SUMARI platform. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool and JBI appraisal tools. Clinical outcomes were synthesized using pairwise and network meta-analyses and pre-post analyses with random-effects models. Analyses were performed in R version 4.2.0. Cost-effectiveness was assessed from a public healthcare payer perspective over a one-year analytic horizon using a decision-tree model, reported in accordance with CHEERS standards.
RESULTS: Twenty-seven studies involving over 6,000 women were included. Network meta-analyses showed that the levonorgestrel-releasing intrauterine system (LNG-IUS) was comparable or superior to commonly used alternatives across key outcomes. Haemoglobin improvement was similar to most comparators, while copper intrauterine devices were associated with poorer outcomes (MD -0.60; 95% CI -0.97 to -0.23). LNG-IUS demonstrated favourable rankings for haemoglobin improvement and menstrual blood loss reduction, with low-to-moderate heterogeneity and no inconsistency. Pre-post analyses showed substantial improvements in haemoglobin, menstrual blood loss, quality of life, and pelvic pain. In the economic evaluation, LNG-IUS reduced per-patient costs (₹7,742 vs ₹15,632), yielding cost savings of ₹7,890 and dominance over comparators.
CONCLUSIONS: LNG-IUS provides meaningful clinical benefits and represents a cost saving, high value intervention within the Indian public healthcare context, supporting its use in health technology assessment informed decision making.