SynthesisBMJ (Clinical research ed.)2011
Hysterectomy, endometrial ablation, and levonorgestrel releasing intrauterine system (Mirena) for treatment of heavy menstrual bleeding: cost effectiveness analysis.
Synthesis in BMJ (Clinical research ed.), 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
36 citing papers in PubMed, 7 syntheses or guidelines pooled it, 129 citations in OpenAlex.
- Pooled it
- Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding.The Cochrane database of systematic reviews · 2021Pooled it
- Progestogen-releasing intrauterine systems for heavy menstrual bleeding.The Cochrane database of systematic reviews · 2020Pooled it
- Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding.The Cochrane database of systematic reviews · 2019Pooled it
- Endometrial resection and ablation techniques for heavy menstrual bleeding.The Cochrane database of systematic reviews · 2019Pooled it
- Levonorgestrel-Releasing Intrauterine System (52 mg) for Idiopathic Heavy Menstrual Bleeding: A Health Technology Assessment.Ontario health technology assessment series · 2016Pooled it
- Levonorgestrel-releasing intrauterine system versus medical therapy for menorrhagia: a systematic review and meta-analysis.Medical science monitor : international medical journal of experimental and clinical research · 2014Pooled it
- The levonorgestrel intrauterine system versus endometrial ablation for heavy menstrual bleeding: a cost-effectiveness analysis.BJOG : an international journal of obstetrics and gynaecology · 2021Trial
- Laparoscopic supracervical hysterectomy versus endometrial ablation for women with heavy menstrual bleeding (HEALTH): a parallel-group, open-label, randomised controlled trial.Lancet (London, England) · 2019Trial
- Trial
- Trial
- Levonorgestrel releasing intrauterine system (Mirena) versus endometrial ablation (Novasure) in women with heavy menstrual bleeding: a multicentre randomised controlled trial.BMC women's health · 2013Trial
- The effects of intrauterine devices on anti-Mullerian hormone levels-a mini-review.Gynecology and pelvic medicine · 2026Review
- How Women Discuss Heavy Menstrual Bleeding in Online Forums ("It's Like Revenge of the Uterus"): Template Approach to Thematic Analysis.Journal of medical Internet research · 2025Article
- Observational
- Rates of medical or surgical treatment for women with heavy menstrual bleeding: the ECLIPSE trial 10-year observational follow-up study.Health technology assessment (Winchester, England) · 2023Observational
- Endometrial ablation and resection versus hysterectomy for heavy menstrual bleeding: an updated systematic review and meta-analysis of effectiveness and complications.Obstetrics & gynecology science · 2023Article
- Cost-effectiveness and budget impact of adding tranexamic acid for management of post-partum hemorrhage in the Indian public health system.BMC pregnancy and childbirth · 2023Article
- Effects of Levonorgestrel-Releasing Intrauterine Device Therapy on Ovarian Reserve in Menorrhagia.Cureus · 2022Article
- Cost-effectiveness of prophylactic hysterectomy in first-degree female relatives with Lynch syndrome of patients diagnosed with colorectal cancer in the United States: a microsimulation study.Cancer medicine · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 5 institutions in 1 country.
Funding
Abstract
objectiveTo undertake a cost effectiveness analysis comparing first and second generation endometrial ablative techniques, hysterectomy, and the levonorgestrel releasing intrauterine system (Mirena) for treating heavy menstrual bleeding.
designModel based economic evaluation with data from an individual patient data meta-analysis supplemented with cost and outcome data from published sources taking an NHS (National Health Service) perspective. A state transition (Markov) model was developed, the structure being informed by the reviews of the trials and clinical input. A subgroup analysis, one way sensitivity analysis, and probabilistic sensitivity analysis were also carried out. POPULATION: Four hypothetical cohorts of women with heavy menstrual bleeding.
interventionsOne of four alternative strategies: Mirena, first or second generation endometrial ablation techniques, or hysterectomy.
main outcome measuresCost effectiveness based on incremental cost per quality adjusted life year (QALY).
resultsHysterectomy is the preferred strategy for the first intervention for heavy menstrual bleeding. Although hysterectomy is more expensive, it produces more QALYs relative to other remaining strategies and is likely to be considered cost effective. The incremental cost effectiveness ratio for hysterectomy compared with Mirena is £1440 (€1633, $2350) per additional QALY. The incremental cost effectiveness ratio for hysterectomy compared with second generation ablation is £970 per additional QALY.
conclusionIn light of the acceptable thresholds used by the National Institute for Health and Clinical Excellence, hysterectomy would be considered the preferred strategy for the treatment of heavy menstrual bleeding. The results concur with those of other studies but are highly sensitive to utility values used in the analysis.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.