{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T11:36:28Z","timestamp":1774611388982,"version":"3.50.1"},"reference-count":45,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2021,7,27]],"date-time":"2021-07-27T00:00:00Z","timestamp":1627344000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["171202001"],"award-info":[{"award-number":["171202001"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the costs and non\u2010inferiority of a strategy starting with the levonorgestrel intrauterine system (LNG\u2010IUS) compared with endometrial ablation (EA) in the treatment of heavy menstrual bleeding (HMB).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cost\u2010effectiveness analysis from a societal perspective alongside a multicentre randomised non\u2010inferiority trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>General practices and gynaecology departments in the Netherlands.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>In all, 270 women with HMB, aged \u226534\u00a0years old, without intracavitary pathology or wish for a future child.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Randomisation to a strategy starting with the LNG\u2010IUS (<jats:italic>n<\/jats:italic>\u00a0=\u00a0132) or EA (<jats:italic>n<\/jats:italic>\u00a0=\u00a0138). The incremental cost\u2010effectiveness ratio was estimated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Direct medical costs and (in)direct non\u2010medical costs were calculated. The primary outcome was menstrual blood loss after 24\u00a0months, measured with the mean Pictorial Blood Assessment Chart\u00a0(PBAC)\u2010score (non\u2010inferiority margin 25 points). A secondary outcome was successful blood loss reduction (PBAC\u2010score \u226475 points).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Total costs per patient were \u20ac2,285 in the LNG\u2010IUS strategy and \u20ac3,465 in the EA strategy (difference: \u20ac1,180). At 24\u00a0months, mean PBAC\u2010scores were 64.8 in the LNG\u2010IUS group (<jats:italic>n<\/jats:italic>\u00a0=\u00a0115) and 14.2 in the EA group (<jats:italic>n<\/jats:italic>\u00a0=\u00a0132); difference 50.5 points (95% CI 4.3\u201396.7). In the LNG\u2010IUS group, 87% of women had a PBAC\u2010score \u226475 points versus 94% in the EA group (relative risk [RR] 0.93, 95% CI 0.85\u20131.01). The ICER was \u20ac23 (95% CI \u20ac5\u2013111) per PBAC\u2010point.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A strategy starting with the LNG\u2010IUS was cheaper than starting with EA, but non\u2010inferiority could not be demonstrated. The LNG\u2010IUS is reversible and less invasive and can be a cost\u2010effective treatment option, depending on the success rate women are willing to accept.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Treatment of heavy menstrual bleeding starting with LNG\u2010IUS is cheaper but slightly less effective than endometrial ablation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.16836","type":"journal-article","created":{"date-parts":[[2021,7,10]],"date-time":"2021-07-10T17:40:02Z","timestamp":1625938802000},"page":"2003-2011","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The levonorgestrel intrauterine system versus endometrial ablation for heavy menstrual bleeding: a cost\u2010effectiveness analysis"],"prefix":"10.1111","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9805-5015","authenticated-orcid":false,"given":"MJ","family":"van den 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