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• W2898025902 abstract "Due to the effectiveness of levonorgestrel (LNG)-intrauterine devices (IUDs) in managing menstrual bleeding and pelvic pain disorders, professional associations recommend their use before hysterectomy.1Collinet P. Fritel X. Revel-Delhom C. et al.Management of endometriosis: CNGOF-HAS practice guidelines (short version).Gynecol Obstet Fertil Senol. 2018; 46 ([in French]): 144-155Google Scholar Among commercially insured women, we observed overall decreases in hysterectomy utilization of 9–17% for abnormal uterine bleeding, uterine leiomyoma, and endometriosis from 2010 through 2013.2Morgan D.M. Kamdar N.S. Swenson C.W. Kobernik E.K. Sammarco A.G. Nallamothu B. Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women.Am J Obstet Gynecol. 2018; 218: 425.e1-425.e18Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar We hypothesized that these decreases in hysterectomy utilization were associated with a concurrently increasing use of LNG-IUD and described financial implications of these changes. This is a retrospective cohort analysis of women aged 35–54 years with commercial insurance in the Health Care Cost Institute (HCCI)—an independent, nonprofit research institute with claims data for >50 million individuals nationwide. LNG-IUD insertion was identified with an International Classification of Diseases, Ninth Revision (ICD-9) procedure code for IUD insertion and a National Drug Code specific for an IUD containing LNG (Supplementary Table). Hysterectomies for bleeding and pain disorders were identified with ICD-9 procedure and diagnostic codes. Endometrial ablations were identified with ICD-9 procedure and Current Procedural Terminology codes. Quarterly utilization rates were adjusted for seasonal variation with autoregressive moving average modeling and for inflation with the medical consumer price index. Changes in utilization and spending for LNG-IUDs, hysterectomy, and endometrial ablation were assessed with generalized linear regression models. Change in number of hysterectomies and endometrial ablations per 100 LNG-IUD insertions was calculated. Cost-effectiveness was modeled with a sensitivity analysis in which success rates for LNG-IUD in avoiding hysterectomy ranging from 50–100% were considered. From 2010 through 2014, there were 6.82 million and 6.48 million women aged 35–54 years in the HCCI. Annual counts of LNG-IUD insertions increased (45,347–75,276) with concomitant decreases in hysterectomies (64,225–52,574) and endometrial ablations (33,435–18,575). Utilization rates and spending are illustrated in Figure 1. Per 10,000 women, the annual utilization rate of LNG-IUD insertion increased from 16.8–28.0, while the rates for hysterectomy decreased from 23.7–19.9 and those for endometrial ablation decreased from 12.3–7.1. Annual spending for LNG-IUDs increased from $32 million–69 million; those for hysterectomy decreased from $500 million–422 million; and those for endometrial ablation decreased from $111 million–64 million. For every 100 LNG-IUDs inserted, there with 31.5 fewer hysterectomies and 45.3 fewer endometrial ablations with savings in spending of $87 million (–13.6%). A sensitivity analysis indicates cost-effectiveness when hysterectomy and endometrial ablation are avoided in at least 61% of women (Figure 2).Figure 2Savings with levonorgestrel IUD use as a function of its success rates in avoiding surgeryShow full captionSpending per 100 levonorgestrel (LNG)-intrauterine device (IUD) insertions for LNG-IUD, hysterectomy, and endometrial ablation, analyzed by success rates of LNG-IUD.Morgan. Savings with expanding use of levonorgestrel IUD. Am J Obstet Gynecol 2019.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Spending per 100 levonorgestrel (LNG)-intrauterine device (IUD) insertions for LNG-IUD, hysterectomy, and endometrial ablation, analyzed by success rates of LNG-IUD. Morgan. Savings with expanding use of levonorgestrel IUD. Am J Obstet Gynecol 2019. From 2010 through 2014, among commercially insured women who are 35–54 years old, there was an annual savings of $87 million related to increasing LNG-IUD use and decreasing use of hysterectomy and endometrial ablation. It is not possible to determine if LNG-IUD was inserted for contraception, control of bleeding and pain, or both. Nonetheless, the medical and financial benefits of increasing LNG-IUD utilization are apparent. Fewer women resort to expensive, invasive treatment and savings are realized. We are unable to determine which women who received LNG-IUD went on to hysterectomy due to inadequate symptom control. While this is a limitation of our analysis, there is evidence that spending related to hysterectomy and its complications are greater than those related to LNG-IUD use, even if hysterectomy is eventually needed.3Hurskainen R. Teperi J. Rissanen P. et al.Clinical outcomes and costs with the levonorgestrel-releasing intrauterine system or hysterectomy for treatment of menorrhagia: randomized trial 5-year follow-up.JAMA. 2004; 291: 1456-1463Crossref PubMed Scopus (287) Google Scholar In this population, assuming that all LNG-IUDs are inserted for menstrual disorders, LNG-IUDs are cost-effective if at least 61% are able to avoid hysterectomy or endometrial ablation." @default.
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• W2898025902 date "2019-01-01" @default.
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• W2898025902 title "Savings with expanding use of the levonorgestrel intrauterine device and fewer benign hysterectomies" @default.
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• W2898025902 doi "https://doi.org/10.1016/j.ajog.2018.10.015" @default.
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