| Titre : | Clinical outcomes and costs with the levonorgestrel-releasing intrauterine system or hysterectomy for treatment of menorrhagia : Randomized trial 5-year follow-up. (2004) |
| Auteurs : | Ritva HURSKAINEN ; Anna-Mari Aalto ; Seija GRENMAN ; Aarre KIVELA ; Krkki KUJANSUU ; Jorma PAAVONEN ; Pekka RISSANEN ; Juha TEPERI ; Sirkku VUORMA ; Merja YLISKOSKI ; Stakes. National Research and Development Center for Welfare and Health. Helsinki. FIN ; University of Helsinki. Departments of Obstetrics and Gynecology. Helsinki. FIN |
| Type de document : | Article |
| Dans : | JAMA - Journal of the american medical association (vol. 291, n° 12, 2004) |
| Pagination : | 1456-1463 |
| Langues: | Anglais |
| Mots-clés : | Pronostic ; Thérapeutique ; Coût ; Economie santé ; Etude comparée ; Homme ; Femme ; Hémorragie ; Utérus [pathologie] ; Epidémiologie ; Appareil génital femelle ; Thérapeutique chirurgicale ; Chirurgie |
| Résumé : | [BDSP. Notice produite par INIST-CNRS R0xTQ68P. Diffusion soumise à autorisation]. Context Because menorrhagia is often a reason for seeking medical attention, it is important to consider outcomes and costs associated with alternative treatment modalities. Both the levonorgestrel-releasing intrauterine system (LNG-IUS) and hysterectomy have proven effective for treatment of menorrhagia but there are no long-term comparative studies measuring cost and quality of life. Objective To compare outcomes, quality-of-life issues, and costs of the LNG-IUS vs hysterectomy in the treatment of menorrhagia. Design, Setting, and Participants Randomized controlled trial conducted between October 1,1994, and October 6,2002, and enrolling 236 women (mean [SD] age, 43 [3.4] years) referred to 5 university hospitals in Finland for complaints of menorrhagia. Interventions Participants were randomly assigned to treatment with the LNG-IUS (n=119) or hysterectomy (n=117) and were monitored for 5 years. Main Outcome Measures Health-related quality of life (HRQL) as measured by the 5-Dimensional EuroQol and the RAND 36-Item Short-Form Health Survey, other measures of psychosocial well-being (anxiety, depression, and sexual function), and costs. Results After 5 years of follow-up, 232 women (99%) were analyzed for the primary outcomes. The 2 groups did not differ substantially in terms of HRQL or psychosocial well-being. Although 50 (42%) of the women assigned to the LNG-IUS group eventually underwent hysterectomy, the discounted direct and indirect costs in the LNG-IUS group ($2817 [95% confidence interval, $2222-$3530] per participant) remained substantially lower than in the hysterectomy group ($4660 [95% confidence interval, $4014-$5180]). Satisfaction with treatment was similar in both groups. Conclusions By providing improvement in HRQL at relatively low cost, the LNG-IUS may offer a wider availability of choices for the patient and may decrease costs due to interventions involving surgery. |
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