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Acta Médica Costarricense

On-line version ISSN 0001-6002Print version ISSN 0001-6012


ESCOBAR-PAREDES, David  and  PERALTA-RIVERA, Rita. Analysis of the cost-effectiveness of the levonorgestrel intrauterine system as alternative to histerectomies in two latin american countries. Acta méd. costarric [online]. 2019, vol.61, n.3, pp.94-98. ISSN 0001-6002.


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.


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.


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.


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.

Keywords : abnormal uterine bleeding; levonorgestrel intrauterine system; hysterectomy; cost-effectiveness.

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