{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T16:53:17Z","timestamp":1782492797175,"version":"3.54.5"},"reference-count":23,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"unspecified","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Shanghai Municipal Science and Technology Commission Medical Innovation Research Special Project","award":["23Y11909100"],"award-info":[{"award-number":["23Y11909100"]}]},{"name":"Shanghai Jiao Tong University Star Science and Technology Innovation Project","award":["YG2021ZD31"],"award-info":[{"award-number":["YG2021ZD31"]}]},{"name":"Shanghai Jiao Tong University Star Science and Technology Innovation Project","award":["YG2023QNB27"],"award-info":[{"award-number":["YG2023QNB27"]}]},{"name":"Shanghai Jiao Tong University Star Science and Technology Innovation Project","award":["YG2024QNA57"],"award-info":[{"award-number":["YG2024QNA57"]}]},{"name":"Shanghai Jiao Tong University Star Science and Technology Innovation Project","award":["YG2024QNA58"],"award-info":[{"award-number":["YG2024QNA58"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,2,24]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the cost-effectiveness of the levonorgestrel intrauterine system (LNG-IUS) compared with hysteroscopic niche resection (HNR) for women with niche-related postmenstrual spotting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Economic evaluation from a healthcare perspective, conducted alongside a randomised controlled trial with 12 months of follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A single-centre study at a university hospital in Shanghai was carried out between October 2019 and January 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 208 women aged 18\u201348 years with niche-related spotting who were suitable for a HNR, defined as a residual myometrium of at least 2.2 mm confirmed by MRI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Participants were randomly assigned to LNG-IUS insertion (n=104) or HNR (n=104).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was reduction in postmenstrual spotting at 6 months, defined as \u226550% decrease in spotting days compared with baseline. Cost-effectiveness was expressed as incremental cost-effectiveness ratios (ICERs), calculated by dividing cost differences in effective rate and spotting days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Statistical analyses<\/jats:title>\n                    <jats:p>Mean costs (diagnostic, examination, surgical) were compared between groups using Student\u2019s t-test, standardised to 2019 price levels. Uncertainty around cost-effectiveness was assessed with non-parametric bootstrapping and cost-effectiveness acceptability curves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At 6 months, 78.4% (80\/102) of women in the LNG-IUS group and 73.1% (76\/104) in the HNR group reported improvement in spotting symptoms (RR 1.07, 95% CI 0.92 to 1.25). Spotting reduction was greater with LNG-IUS (0.0 days, IQR 0.0 to 2.8) compared with HNR (2.0 days, IQR 0.8 to 4.3; p&lt;0.001). Mean costs were significantly lower in the LNG-IUS group (\uffe52273.8 RenMinBi (RMB)) versus the HNR group (\uffe56318.0 RMB), with a mean cost difference of \u2212\uffe54044.2 RMB (95% CI \u22124367.3 to \u22123721.1). The ICER of LNG-IUS over HNR was \u2212\uffe5763.2 RMB per one-percentage-point effective rate gained. Each day reduction in spotting was associated with cost savings of \uffe51833.8 RMB. The probability of LNG-IUS being dominant was 0.99 at a willingness-to-pay (WTP) of \uffe50 RMB and 0.97 at WTP \uffe510\u2009000 RMB per effective rate point, and 0.99 and 0.60, respectively, per spotting day reduced.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LNG-IUS is highly cost-effective compared with HNR for the treatment of niche-related postmenstrual spotting at 6 months. These findings support LNG-IUS as first-line therapy for niche-related spotting in women with a residual myometrium \u22652.2 mm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>ChiCTR1900025677.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-090247","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T12:55:14Z","timestamp":1773406514000},"page":"e090247","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness of levonorgestrel intrauterine system versus hysteroscopic niche resection for caesarean scar\u2013related spotting in China: an economic evaluation alongside a randomised controlled trial"],"prefix":"10.1136","volume":"16","author":[{"given":"Chenfeng","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, International Peace Maternity and Child Health Hospital\/School of Medicine, Shanghai Jiao Tong University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, International Peace Maternity and Child Health Hospital\/School of Medicine, Shanghai Jiao Tong University, Shanghai, China"},{"name":"Department of Obstetrics and Gynaecology, Shanghai Jiao Tong University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lirong","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Shanghai Jiao Tong University, Shanghai, China"},{"name":"Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoya","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, International Peace Maternity and Child Health Hospital, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Shanghai Jiao Tong University, Shanghai, China"},{"name":"Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6540-2268","authenticated-orcid":false,"given":"Chuqing","family":"He","sequence":"additional","affiliation":[{"name":"International Peace Maternity and Child Health Hospital, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of 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