COMPARATIVE EFFECTIVENESS AND COST-EFFECTIVENESS OF LNG-IUS VERSUS ORAL THERAPY FOR ABNORMAL UTERINE BLEEDING IN A RESOURCE-LIMITED SETTING
Author(s)
Manoj Kumar Mudigubba, PharmD, PhD, MPH1, Jashuva T, PharmD2.
1Professor & HoD, Raghavendra Institute of Pharmaceutical Education and research, Anantapur, India, 2Raghavendra Institute of Pharmaceutical Education & Research (RIPER), Anantapur, India.
1Professor & HoD, Raghavendra Institute of Pharmaceutical Education and research, Anantapur, India, 2Raghavendra Institute of Pharmaceutical Education & Research (RIPER), Anantapur, India.
OBJECTIVES: Abnormal uterine bleeding (AUB) is a prevalent gynecological condition associated with heavy menstrual bleeding, reduced quality of life, and substantial healthcare costs. Although the levonorgestrel‑releasing intrauterine system (LNG‑IUS) is clinically effective, its higher upfront cost limits adoption in resource‑constrained settings. This study aimed to compare the clinical effectiveness and cost‑effectiveness of LNG‑IUS versus oral hormonal formulations in women with AUB.
METHODS: A retrospective observational study was conducted at a tertiary care hospital, including 96 women diagnosed with AUB. Patients were divided into two equal groups: LNG‑IUS (n=48) and oral hormonal therapy (n=48). Clinical effectiveness was assessed using Pictorial Blood Assessment Chart (PBAC) scores, responder rate (<100 PBAC), and outcome categories (success, hysterectomy, treatment switch). Economic evaluation included direct medical costs (device, medications, consultations) and indirect costs (productivity loss). Statistical analyses included Mann-Whitney U and Kruskal-Wallis tests. Incremental cost‑effectiveness ratio (ICER) and a decision‑tree model were used to estimate cost per additional successful outcome.
RESULTS: All patients presented with PBAC >100 at baseline. LNG‑IUS demonstrated significantly greater reduction in PBAC scores at follow‑up compared with oral therapy (p<0.001). The responder rate was higher in the LNG‑IUS group (64.6%) than in the oral group (27.1%). Overall treatment success was 66.7% for LNG‑IUS versus 12.5% for oral therapy. Although LNG‑IUS incurred higher upfront device costs, oral therapy resulted in higher cumulative medication expenses. The ICER was ₹8,870.61 per additional successful outcome in the primary analysis and ₹6,141.19 in the decision‑tree model, indicating favorable cost‑effectiveness for LNG‑IUS.
CONCLUSIONS: LNG‑IUS provides superior clinical outcomes and is a cost‑effective treatment option for AUB compared with oral hormonal therapy. Despite higher initial costs, LNG‑IUS yields greater long‑term effectiveness and reduced need for surgical interventions, supporting its broader adoption in low‑resource healthcare settings.
METHODS: A retrospective observational study was conducted at a tertiary care hospital, including 96 women diagnosed with AUB. Patients were divided into two equal groups: LNG‑IUS (n=48) and oral hormonal therapy (n=48). Clinical effectiveness was assessed using Pictorial Blood Assessment Chart (PBAC) scores, responder rate (<100 PBAC), and outcome categories (success, hysterectomy, treatment switch). Economic evaluation included direct medical costs (device, medications, consultations) and indirect costs (productivity loss). Statistical analyses included Mann-Whitney U and Kruskal-Wallis tests. Incremental cost‑effectiveness ratio (ICER) and a decision‑tree model were used to estimate cost per additional successful outcome.
RESULTS: All patients presented with PBAC >100 at baseline. LNG‑IUS demonstrated significantly greater reduction in PBAC scores at follow‑up compared with oral therapy (p<0.001). The responder rate was higher in the LNG‑IUS group (64.6%) than in the oral group (27.1%). Overall treatment success was 66.7% for LNG‑IUS versus 12.5% for oral therapy. Although LNG‑IUS incurred higher upfront device costs, oral therapy resulted in higher cumulative medication expenses. The ICER was ₹8,870.61 per additional successful outcome in the primary analysis and ₹6,141.19 in the decision‑tree model, indicating favorable cost‑effectiveness for LNG‑IUS.
CONCLUSIONS: LNG‑IUS provides superior clinical outcomes and is a cost‑effective treatment option for AUB compared with oral hormonal therapy. Despite higher initial costs, LNG‑IUS yields greater long‑term effectiveness and reduced need for surgical interventions, supporting its broader adoption in low‑resource healthcare settings.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE255
Topic
Clinical Outcomes, Economic Evaluation
Disease
Reproductive & Sexual Health