Trial reportBMJ open2026
Cost-effectiveness of levonorgestrel intrauterine system versus hysteroscopic niche resection for caesarean scar-related spotting in China: an economic evaluation alongside a randomised controlled trial.
Trial report in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Authors and funding
11 authors.
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Abstract
objectiveTo evaluate the cost-effectiveness of the levonorgestrel intrauterine system (LNG-IUS) compared with hysteroscopic niche resection (HNR) for women with niche-related postmenstrual spotting.
designEconomic evaluation from a healthcare perspective, conducted alongside a randomised controlled trial with 12 months of follow-up.
settingA single-centre study at a university hospital in Shanghai was carried out between October 2019 and January 2021.
participantsA total of 208 women aged 18-48 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.
interventionParticipants were randomly assigned to LNG-IUS insertion (n=104) or HNR (n=104).
main outcome measuresThe primary outcome was reduction in postmenstrual spotting at 6 months, defined as ≥50% 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. STATISTICAL ANALYSES: Mean costs (diagnostic, examination, surgical) were compared between groups using Student's t-test, standardised to 2019 price levels. Uncertainty around cost-effectiveness was assessed with non-parametric bootstrapping and cost-effectiveness acceptability curves.
resultsAt 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<0.001). Mean costs were significantly lower in the LNG-IUS group (￥2273.8 RenMinBi (RMB)) versus the HNR group (￥6318.0 RMB), with a mean cost difference of -￥4044.2 RMB (95% CI -4367.3 to -3721.1). The ICER of LNG-IUS over HNR was -￥763.2 RMB per one-percentage-point effective rate gained. Each day reduction in spotting was associated with cost savings of ￥1833.8 RMB. The probability of LNG-IUS being dominant was 0.99 at a willingness-to-pay (WTP) of ￥0 RMB and 0.97 at WTP ￥10 000 RMB per effective rate point, and 0.99 and 0.60, respectively, per spotting day reduced.
conclusionsLNG-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 ≥2.2 mm. TRIAL REGISTRATION NUMBER: ChiCTR1900025677.
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