<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0001-6002</journal-id>
<journal-title><![CDATA[Acta Médica Costarricense]]></journal-title>
<abbrev-journal-title><![CDATA[Acta méd. costarric]]></abbrev-journal-title>
<issn>0001-6002</issn>
<publisher>
<publisher-name><![CDATA[Colegio de Médicos y Cirujanos de Costa Rica]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0001-60022019000300094</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Análisis de la costo-efectividad del sistema intrauterino liberador de levonorgestrel, como alternativa a histerectomías, en dos países latinoamericanos]]></article-title>
<article-title xml:lang="en"><![CDATA[Analysis of the cost-effectiveness of the levonorgestrel intrauterine system as alternative to histerectomies in two latin american countries]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Escobar-Paredes]]></surname>
<given-names><![CDATA[David]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Peralta-Rivera]]></surname>
<given-names><![CDATA[Rita]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Chile Hospital Clínico San Borja-Arriarán Servicio de Obstetricia, Ginecología y Neonatología]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Chile</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de Costa Rica Servicio Ginecología Hospital &#8220;Dr. Rafael Ángel Calderón Guardia ]]></institution>
<addr-line><![CDATA[San José ]]></addr-line>
<country>Costa Rica.</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>09</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>09</month>
<year>2019</year>
</pub-date>
<volume>61</volume>
<numero>3</numero>
<fpage>94</fpage>
<lpage>98</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_arttext&amp;pid=S0001-60022019000300094&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_abstract&amp;pid=S0001-60022019000300094&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_pdf&amp;pid=S0001-60022019000300094&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Objetivo:  El sistema intrauterino con levonorgestrel ha demostrado un fuerte efecto supresor endometrial de mucha utilidad en gran variedad de problemas ginecológicos. Existen numerosos estudios y revisiones del sistema intrauterino con levonorgestrel que avalan su uso en sangrado uterino anormal, como también bastantes publicaciones que demuestran su costo-efectividad. No se encontraron publicaciones latinoamericanas. El objetivo del estudio es desarrollar un modelo para valorar el beneficio en costos del uso del dispositivo como manejo alternativo del sangrado uterino anormal.  Métodos :  Se realizó modelo fármaco-económico que ayudará a comparar costos y efectividad de sistema intrauterino con levonorgestrel, inserción, controles clínicos más ultrasonido transvaginal al mes, y anuales, y se comparó con los costos directos de histerectomía. Los costos de histerectomía se obtienen mediante GRD-WinSIG en Chile y los costos reales directos en Costa Rica. El modelo es básicamente comparar los costos de la inserción de sistema intrauterino con levonorgestrel más las fallas del tratamiento versus histerectomías.  Resultados:  El modelo permite demostrar que al utilizar el sistema intrauterino con levonorgestrel como alternativa a la histerectomía en pacientes seleccionadas, se produce un ahorro en costos, aun asumiendo el costo de las fallas. Estos modelos no consideran los costos asociados a las complicaciones eventuales de todo acto quirúrgico, de tal forma que el ahorro generado por el uso del sistema intrauterino con levonorgestrel podría ser mayor.  Conclusión:  La inclusión del sistema intrauterino con levonorgestrel en guías de práctica clínica permite la posibilidad de disminuir las histerectomías en pacientes refractarias a tratamiento médico convencional, y que cumplan con criterios de inclusión y exclusión estrictos. El modelo permitió demostrar que al utilizar el sistema intrauterino con levonorgestrel como alternativa a la histerectomía, se produce un gasto que es solo un tercio del generado al realizar histerectomías.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Summary  Objective:  The intrauterine system with levonorgestrel has demonstrated a strong endometrial suppressive effect that is useful in a wide variety of gynecological problems. There are numerous studies and reviews of the levonorgestrel intrauterine system that support its use in abnormal uterine bleeding, as well as numerous publications that demonstrate its cost-effectiveness. As far as we know, there are no Latin American publications in this regard. The objective of the present study was to develop a model to assess the costs benefits of the use of the devices as alternative management of abnormal uterine bleeding.  Methods:  A pharmacoeconomic model was performed comparing costs and effectiveness with costs of levonorgestrel intrauterine system, insertion, clinical controls plus ultrasounds per month and annually, compared with the direct costs of hysterectomy. Hysterectomy costs were obtained through DRG-WinSIG or direct real costs in Chile and Costa Rica respectively.  Results:  Our model demonstratde that when using the levonorgestrel intrauterine systsem as an alternative to hysterectomy in selected patients there is an expenditure of only one third of the costs of performing the hysterectomies in the same patients, even assuming failures with the dispositive. These model did not consider the costs associated with the eventual complications of any surgical act, thus, savings generated by use of the levonorgestrel intrauterine system in these patients could be even greater.  Conclusión: The inclusion of the levonorgestrel intrauterine system in clinical practice guidelines could allow the possibility of reducing hysterectomies in patients refractory to conventional medical treatment and who meet strict inclusion and exclusion criteria. Our models demonstrate that when using the levonorgestrel intrauterine system as an alternative to hysterectomy in selected patients there is a reduction in costs.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[sangrado uterino anormal]]></kwd>
<kwd lng="es"><![CDATA[sistema intrauterino con levonorgestrel]]></kwd>
<kwd lng="es"><![CDATA[histerectomía]]></kwd>
<kwd lng="es"><![CDATA[costo - efectividad]]></kwd>
<kwd lng="en"><![CDATA[abnormal uterine bleeding]]></kwd>
<kwd lng="en"><![CDATA[levonorgestrel intrauterine system]]></kwd>
<kwd lng="en"><![CDATA[hysterectomy]]></kwd>
<kwd lng="en"><![CDATA[cost-effectiveness]]></kwd>
</kwd-group>
</article-meta>
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