The Levonorgestrel Intrauterine System (Lng-Ius) For Prevention Of Endometrial Cancer In Women With Obesity Is Cost Effective

Objectives: To estimate the cost-effectiveness of the levonorgestrel intrauterine system (LNG-IUS) as an endometrial cancer prevention strategy in women with obesity. Methods: A Markov decision-analytic model was used to compare 5 strategies in women with a body mass index of 30 or greater: 1) Usual care 2) LNG-IUS for 5 years 3) LNG-IUS for 7 years 4) LNG-IUS for 5 years, replaced once for a total of 10 years 5) LNG-IUS for 7 years, replaced once for a total of 14 years. Obesity was presumed to be associated with a 3-fold relative risk of endometrial cancer incidence and a 2.65-fold disease-specific mortality. The LNG-IUS was assumed to confer a 50% reduction in cancer incidence over the period of the LNG-IUS insertion. Costs of LNG-IUS and cancer care were included. Outcomes were incremental cost-effectiveness ratios, calculated in 2019 Canadian dollars per year of life saved. One-way and two-way sensitivity analyses were performed. Results: The LNG-IUS strategy was considered cost-effective if the cost of the intervention is less than 66 400 CAD (50 000 USD) per year of life saved. The strategy becomes cost-effective if 1 LNG-IUS is inserted in 57-year-old women for 5 years, 1 LNG-IUS is inserted in 52-year-old women for 7 years, 2 subsequent LNG-IUS for a total of 10 years are inserted in 51-year-old women or 2 subsequent LNG-IUS for a total of 14 years are inserted in 45-year-old women, when compared to usual care. The results are stable to variations in cost but sensitive to the estimated risk reduction of the LNG-IUS and the impact of obesity on endometrial cancer incidence and disease-specific mortality. Conclusions: The LNG-IUS is a cost-effective method of endometrial cancer prevention in women with obesity. This intervention warrants investigation in a prospective study in this high-risk population. To estimate the cost-effectiveness of the levonorgestrel intrauterine system (LNG-IUS) as an endometrial cancer prevention strategy in women with obesity. A Markov decision-analytic model was used to compare 5 strategies in women with a body mass index of 30 or greater: 1) Usual care 2) LNG-IUS for 5 years 3) LNG-IUS for 7 years 4) LNG-IUS for 5 years, replaced once for a total of 10 years 5) LNG-IUS for 7 years, replaced once for a total of 14 years. Obesity was presumed to be associated with a 3-fold relative risk of endometrial cancer incidence and a 2.65-fold disease-specific mortality. The LNG-IUS was assumed to confer a 50% reduction in cancer incidence over the period of the LNG-IUS insertion. Costs of LNG-IUS and cancer care were included. Outcomes were incremental cost-effectiveness ratios, calculated in 2019 Canadian dollars per year of life saved. One-way and two-way sensitivity analyses were performed. The LNG-IUS strategy was considered cost-effective if the cost of the intervention is less than 66 400 CAD (50 000 USD) per year of life saved. The strategy becomes cost-effective if 1 LNG-IUS is inserted in 57-year-old women for 5 years, 1 LNG-IUS is inserted in 52-year-old women for 7 years, 2 subsequent LNG-IUS for a total of 10 years are inserted in 51-year-old women or 2 subsequent LNG-IUS for a total of 14 years are inserted in 45-year-old women, when compared to usual care. The results are stable to variations in cost but sensitive to the estimated risk reduction of the LNG-IUS and the impact of obesity on endometrial cancer incidence and disease-specific mortality. The LNG-IUS is a cost-effective method of endometrial cancer prevention in women with obesity. This intervention warrants investigation in a prospective study in this high-risk population.