COST EFFECTIVENESS ANALYSIS OF THE USE OF IUS-LNG AGAINST ORAL CONTRACEPTIVES AND NSAIDS, FOR THE TREATMENT OF HEAVY MESTRUAL BLEEDING IN COLOMBIA

OBJECTIVES: To estimate the cost-effectiveness ratios for the use of IUS-LNG versus the use of oral contraceptives and three NSAIDs (mefenamic acid, tranexamic acid and naproxen) for the treatment of heavy menstrual bleeding in Colombia METHODS: A Markov model was developed to estimate the rate of bleeding control evaluating frequency of hysterectomies as the main clinical outcome and the total healthcare costs. The base case is patients with excessive loss of menstrual blood that affect quality of life related to health. It uses a 12-month horizon, with monthly cycles. The chances of menstrual bleeding control were estimated from clinical trials. It includes the costs of the technologies extracted from local data base and the events from insurance costs. Healthcare costs included: hysterectomies with their complications and ablation. RESULTS: IUS-LNG was found as the technology that prevents the largest number of hysterectomies in one yean 72% of patients treated with the IUS-LNG did not arrive to hysterectomy, compared to 45% of patients under oral contraceptives and 41% under NSAIDS. In terms of average costs, patients treated with IUS-LNG, ACOs and NSAIDs are estimated at USD $438, USD $507 and USD $751, respectively. Thus, IUS-LNG is considered a dominant technology in the control of heavy menstrual bleeding CONCLUSIONS: IUS-LNG is a dominant first line alternative compared to other technologies covered by the Colombian health care system reducing between 13,5% and 41,5% of costs and avoiding between 49,0,% and 53,3% histerectomies versus other non-surgical options as NSAIDs and ACOs, respectively.