Cost effectiveness of endometrial ablation with the NovaSure^® system versus other global ablation modalities and hysterectomy for treatment of abnormal uterine bleeding: US commercial and Medicaid payer perspectives

Figures & data

Figure 1 Clinical pathways within the AUB treatment cost-effectiveness model.

Note: *Excludes hysterectomy.
Abbreviations: AUB, abnormal uterine bleeding; GEA, global endometrial ablation; HT, hormone therapy; IUD, intrauterine device; LNG-IUS, levonorgestrel intrauterine system.

Table 1 Direct costs

AUB treatment	Intervention and 30-day follow-up costs (SE)		Reintervention/adjunctive/alternative pharmacotherapy and 30-day follow-up costs(SE)		Monthly gynecologic-related costs (SE) after follow-up
	Without complication(s)	With complication(s)	Without complication(s)	With complication(s)
Commercial payer perspective
NovaSure†	$5,951 ($22)	$7,676 ($83)	$5,892 ($93)	$7,926 ($185)	$14.25 ($0.66)
Other GEA	$5,951 ($22)	$7,676 ($83)	$5,892 ($93)	$7,926 ($185)	$14.25 ($0.66)
Hysterectomy	$12,318 ($69)	$14,017 ($127)	$13,072 ($162)	$15,149 ($243)	$27.51 ($1.53)
Tranexamic acid	–	–	$830 ($89)	$5,439 ($198)	$48.49 ($1.68)
LNG-IUS	–	–	$1,463 ($88)	$2,988 ($232)	$23.33 ($5.29)
Adjunctive/alternative pharmacotherapy‡	–	–	$830 ($89)	$5,439 ($198)	$48.49 ($1.68)
Medicaid perspective
NovaSure†	$3,678 ($147)	$5,148 ($531)	$3,454 ($289)	$11,173 ($5,384)	$16.91 ($3.56)
Other GEA	$3,678 ($147)	$5,148 ($531)	$3,454 ($289)	$11,173 ($5,384)	$16.91 ($3.56)
Hysterectomy	$10,453 ($515)	$13,422 ($630)	$12,199 ($935)	$13,929 ($1,354)	$67.08 ($31.86)
Tranexamic acid	–	–	$2,345 ($1,285)	$9,472 ($3,563)	$70.28 ($11.78)
LNG-IUS	–	–	$1,335 ($427)	$1,065 ($80)	$10.21 ($5.90)
Adjunctive/alternative pharmacotherapy‡	–	–	$2,345 ($1,285)	$9,472 ($3,563)	$70.28 ($11.78)

Notes: Data from Bonafede et al;^30,31 posters (#PIH17 and #PIH22) presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 18th Annual International Meeting, May 18–22; 2013; New Orleans, LA. Available from: http://www.ispor.org/research_pdfs/43/pdffiles/PIH17.pdf and http://www.ispor.org/research_pdfs/43/pdffiles/PIH22.pdf. Data also adapted from Bonafede MM, Miller JD, Laughlin-Tommaso SK, Lukes AS, Meyer NM, Lenhart GM. Retrospective database analysis of clinical outcomes and costs for treatment of abnormal uterine bleeding among women enrolled in US Medicaid programs. Clinicoecon Outcomes Res. 2014;6: 423–429. Copyright © 2014 Dove Medical Press.³⁷ Due to data limitations, values for tranexamic acid are assumed to be the same as those for adjunctive pharmacotherapy (ie, non-IUD hormonal therapies). All costs in 2013 US dollars.

† NovaSure direct costs assumed to be the same as other GEA.

‡ Adjunctive/alternative pharmacotherapy comprises assorted non-IUD hormonal therapies used adjunctively after intervention/reintervention with NovaSure or other GEA or alternatively after reintervention with LNG-IUS.

Abbreviations: AUB, abnormal uterine bleeding; GEA, global endometrial ablation; IUD, intrauterine device; LNG-IUS, levonorgestrel intrauterine system; SE, standard error.

Table 4 Health state utilities (both commercial and Medicaid payer perspectives)

AUB treatment and scenario	Utility (SE)	Source
Intervention without complications
NovaSure	0.76 (0.04)	Assumed to be the same as other GEA
Other GEA	0.76 (0.04)	Ref ^Citation32,33
Hysterectomy (Month 1)	0.56 (0.05)	Ref ^Citation32,33, as adapted from Ref ^Citation52
Hysterectomy (Months 2–3)	0.74 (0.05)	Ref ^Citation32,33, as adapted from Ref ^Citation52
Intervention with complications
NovaSure	0.50 (0.04)	Assumed to be the same as other GEA
Other GEA	0.50 (0.04)	Assumed to be the average (rounded to two decimal places) of “severe complications post-second-generation EA” (ie, 0.49, as derived from Ref ^Citation34) and “symptomatic post-second-generation EA” (ie, 0.50, as derived from the utility value of “menorrhagia” presented by Ref ^Citation52) as presented in the economic models developed by Ref ^Citation32,Citation33
Hysterectomy (Month 1)	0.49 (0.00)	Ref ^Citation32,33, as derived from Ref ^Citation34^–^Citation36
Hysterectomy (convalescent Months 2–3)	0.49 (0.00)	Assumed to be the same as hysterectomy with complications in Month 1
Reintervention or adjunctive/alternative pharmacotherapy without complications
NovaSure	0.76 (0.04)	Assumed to be the same as other GEA
Other GEA	0.76 (0.04)	Ref ^Citation32,Citation33
Hysterectomy (Month 1)	0.56 (0.05)	Ref ^Citation32,Citation33 as adapted from Ref ^Citation52
Hysterectomy (Months 2–3)	0.74 (0.05)	Ref ^Citation32,Citation33 as adapted from Ref ^Citation52
Tranexamic acid	0.84 (0.05)	Assumed to be the same as LNG-IUS
LNG-IUS	0.84 (0.05)	Same as the “well” state health utility for LNG-IUS, as was also assumed by Ref ^Citation32,Citation33 as derived from Ref ^Citation53
Adjunctive/alternative pharmacotherapy*	0.84 (0.05)	Assumed to be the same as LNG-IUS
Reintervention or adjunctive/alternative pharmacotherapy with complications
NovaSure	0.50 (0.04)	Assumed to be the same as other GEA
Other GEA	0.50 (0.04)	Assumed to be the average (rounded to two decimal places) of “severe complications post-second-generation EA” (ie, 0.49, as derived from Ref ^Citation34) and “symptomatic post-second-generation EA” (ie, 0.50, as derived from the utility value of “menorrhagia” presented by Ref ^Citation52) as presented in the economic models developed by Ref ^Citation32,Citation33
Hysterectomy (Month 1)	0.49 (0.00)	Ref ^Citation32,Citation33 as derived from Ref ^Citation34^–^Citation36
Hysterectomy (convalescent Months 2–3)	0.49 (0.00)	Assumed to be the same as hysterectomy with complications in Month 1
Tranexamic acid	0.50 (0.04)	Assumed to be the same as intervention with LNG-IUS with complications
LNG-IUS	0.50 (0.04)	Assumed to be the same as “symptomatic post-Mirena” as presented in the economic models developed by Ref ^Citation32,Citation33 as derived from the utility value of “menorrhagia” presented by Ref ^Citation52
Adjunctive/alternative pharmacotherapy*	0.50 (0.04)	Assumed to be the same as intervention with LNG-IUS with complications
Well
NovaSure	0.84 (0.05)	Assumed to be the same as other GEA
Other GEA	0.84 (0.05)	Assumed the same as “well post-second-generation EA”, per Ref ^Citation32,Citation33 as derived from Ref ^Citation53
Hysterectomy (post-convalescence)	0.88 (0.05)	Assumed same as “well post-hysterectomy”, per Ref ^Citation32,Citation33 as derived from Ref ^Citation53
Tranexamic acid	0.84 (0.05)	Assumed to be the same as LNG-IUS
LNG-IUS	0.84 (0.05)	Assumed same as “well post-Mirena”, per Ref ^Citation32,Citation33, as derived from Ref ^Citation53
Non-IUD hormonal therapies	0.84 (0.05)	Assumed to be the same as LNG-IUS
Dead
All treatment arms	0.00 (0.00)	Standard assumption

Note:

* Adjunctive/alternative pharmacotherapy comprises assorted non-IUD hormonal therapies used adjunctively after intervention/reintervention with NovaSure or other GEA or alternatively after reintervention with LNG-IUS.

Abbreviations: AUB, abnormal uterine bleeding; EA, endometrial ablation; GEA, global endometrial ablation; IUD, intrauterine device; LNG-IUS, levonorgestrel intrauterine system; SE, standard error; Ref, reference.

Table 6 Mortality (both commercial and Medicaid payer perspectives)

AUB treatment arm	Probability	Source
Intervention/reintervention mortality (per event)
NovaSure	0.00000	Assumed to be the same as other GEA
Other GEA	0.00000	Same assumption used by Ref ^Citation33 for “second-generation EA”
Hysterectomy	0.00038	Ref ^Citation32,Citation33 as derived from Ref ^Citation54
Tranexamic acid	–	Not applicable
LNG-IUS	0.00000	Consistent with assumption used by Ref ^Citation33 for LNG-IUS
Adjunctive/alternative pharmacotherapy*	–	Not applicable
Background mortality (per month)
All interventions/reinterventions	0.00021	US life table for 2009 published by the US Social Security Administration†

Notes:

* Adjunctive/alternative pharmacotherapy comprises assorted non-IUD hormonal therapies used adjunctively after intervention/reintervention with NovaSure or other GEA or alternatively after reintervention with LNG-IUS.

† Calculated as the average probability of women dying within 1 year for the 10-year timespan encompassing ages 42–51 years, divided by 12 months per year to yield a monthly probability. US Social Security Administration, Office of the Chief Actuary. 2009 Actuarial Life Table. Available online at http://www.ssa.gOv/oact/STATS/table4c6.html#ss (accessed June 19, 2014).

Abbreviations: AUB, abnormal uterine bleeding; EA, endometrial ablation; GEA, global endometrial ablation; IUD, intrauterine device; LNG-IUS, levonorgestrel intrauterine system.

Table 2 Monthly probabilities of reintervention and adjunctive/alternative pharmacotherapy†

AUB treatment	Monthly probability (SE) of reintervention	Distribution by type of reintervention utilized					Monthly probability (SE) of adjunctive/alternative pharmacotherapy†
		NovaSure	Other GEA	Hysterectomy	Tranexamic acid^‡	LNG-IUS
Commercial payer perspective
First year post-intervention
Intervention
NovaSure	0.0044 (0.0001)	0.0868	–	0.8829	0.0032	0.0271	0.0033 (0.0001)
Other GEA	0.0050 (0.0001)	–	0.0868	0.8829	0.0032	0.0271	0.0033 (0.0001)
Hysterectomy	–	–	–	–	–	–	–
Reintervention
NovaSure	0.0044 (0.0001)	0.0868	–	0.8829	0.0032	0.0271	0.0033 (0.0001)
Other GEA	0.0050 (0.0001)	–	0.0868	0.8829	0.0032	0.0271	0.0033 (0.0001)
Tranexamic acid	0.0206 (0.0003)	–	0.4210	0.5286	0.0000	0.0505	0.0000 (0.0000)
LNG-IUS	0.0114 (0.0010)	–	0.3259	0.3839	0.0089	0.2812	0.0071 (0.0010)
Adjunctive/alternative pharmacotherapy†	0.0206 (0.0003)	–	0.4199	0.5272	0.0026	0.0504	–
Second year post-intervention
Intervention
NovaSure	0.0014 (0.0001)	0.0641	–	0.9108	0.0092	0.0160	0.0011 (0.0001)
Other GEA	0.0016 (0.0001)	–	0.0641	0.9108	0.0092	0.0160	0.0011 (0.0001)
Hysterectomy	–	–	–	–	–	–	–
Reintervention
NovaSure	0.0014 (0.0001)	0.0641	–	0.9108	0.0092	0.0160	0.0011 (0.0001)
Other GEA	0.0016 (0.0001)	–	0.0641	0.9108	0.0092	0.0160	0.0011 (0.0001)
Tranexamic acid	0.0024 (0.0001)	–	0.3508	0.5628	0.0000	0.0864	0.0000 (0.0000)
LNG-IUS	0.0017 (0.0004)	–	0.2500	0.5500	0.0000	0.2000	0.0011 (0.0004)
Adjunctive/alternative pharmacotherapy†	0.0024 (0.0001)	–	0.3463	0.5556	0.0129	0.0853	–
Third year post-intervention
Intervention
NovaSure	0.0025 (0.0002)	0.0616	–	0.9242	0.0000	0.0142	0.0019 (0.0002)
Other GEA	0.0027 (0.0002)	–	0.0616	0.9242	0.0000	0.0142	0.0019 (0.0002)
Hysterectomy	–	–	–	–	–	–	–
Reintervention
NovaSure	0.0025 (0.0002)	0.0616	–	0.9242	0.0000	0.0142	0.0019 (0.0002)
Other GEA	0.0027 (0.0002)	–	0.0616	0.9242	0.0000	0.0142	0.0019 (0.0002)
Tranexamic acid	0.0043 (0.0002)	–	0.4172	0.4331	0.0000	0.1497	0.0000 (0.0000)
LNG-IUS	0.0028 (0.0008)	–	0.4706	0.4706	0.0000	0.0588	0.0023 (0.0008)
Adjunctive/alternative pharmacotherapy†	0.0043 (0.0002)	–	0.4153	0.4312	0.0045	0.1490	–
Medicaid perspective
First year post-intervention
Intervention
NovaSure	0.0044 (0.0013)	0.1078	0.1078	0.8824	0.0000	0.0098	0.0053 (0.0013)
Other GEA	0.0105 (0.0013)	–	0.1078	0.8824	0.0000	0.0098	0.0053 (0.0013)
Hysterectomy	–	–	–	–	–	–	–
Reintervention
NovaSure	0.0044 (0.0013)	0.1078	0.1078	0.8824	0.0000	0.0098	0.0053 (0.0013)
Other GEA	0.0105 (0.0013)	–	0.1078	0.8824	0.0000	0.0098	0.0053 (0.0013)
Tranexamic acid	0.0228 (0.0013)	–	0.3406	0.6219	0.0000	0.0375	0.0000 (0.0000)
LNG-IUS	0.0229 (0.0063)	–	0.2941	0.4118	0.0000	0.2941	0.0067 (0.0063)
Adjunctive/alternative harmacotherapy†	0.0228 (0.0013)	–	0.3396	0.6199	0.0031	0.0374	–
Second year post-intervention
Intervention
NovaSure	0.0014 (0.0005)	0.0641	0.0641	0.9108	0.0092	0.0160	0.0023 (0.0005)
Other GEA	0.0034 (0.0005)	–	0.0641	0.9108	0.0092	0.0160	0.0023 (0.0005)
Hysterectomy	–	–	–	–	–	–	–
Reintervention
NovaSure	0.0014 (0.0005)	0.0641	0.0641	0.9108	0.0092	0.0160	0.0023 (0.0005)
Other GEA	0.0034 (0.0005)	–	0.0641	0.9108	0.0092	0.0160	0.0023 (0.0005)
Tranexamic acid	0.0032 (0.0002)	–	0.3508	0.5628	0.0000	0.0864	0.0000 (0.0000)
LNG-IUS	0.0031 (0.0011)	–	0.2500	0.5500	0.0000	0.2000	0.0020 (0.0011)
Adjunctive/alternative pharmacotherapy†	0.0032 (0.0002)	–	0.3463	0.5556	0.0129	0.0853	–
Third year post-intervention
Intervention
NovaSure	0.0025 (0.0008)	0.0616	0.0616	0.9242	0.0000	0.0142	0.0040 (0.0008)
Other GEA	0.0058 (0.0008)	–	0.0616	0.9242	0.0000	0.0142	0.0040 (0.0008)
Hysterectomy	–	–	–	–	–	–	–
Reintervention
NovaSure	0.0025 (0.0008)	0.0616	0.0616	0.9242	0.0000	0.0142	0.0040 (0.0008)
Other GEA	0.0058 (0.0008)	–	0.0616	0.9242	0.0000	0.0142	0.0040 (0.0008)
Tranexamic acid	0.0057 (0.0003)	–	0.4172	0.4331	0.0000	0.1497	0.0000 (0.0000)
LNG-IUS	0.0052 (0.0020)	–	0.4706	0.4706	0.0000	0.0588	0.0043 (0.0020)
Adjunctive/alternative pharmacotherapy†	0.0057 (0.0003)	–	0.4153	0.4312	0.0045	0.1490	–

Notes: Data from Bonafede et al;^30,31 posters (#PIH17 and #PIH22) presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 18th Annual International Meeting, May 18–22; 2013; New Orleans, LA. Available from: http://www.ispor.org/research_pdfs/43/pdffiles/PIH17.pdf and http://www.ispor.org/research_pdfs/43/pdffiles/PIH22.pdf. Data also adapted from Bonafede MM, Miller JD, Laughlin-Tommaso SK, Lukes AS, Meyer NM, Lenhart GM. Retrospective database analysis of clinical outcomes and costs for treatment of abnormal uterine bleeding among women enrolled in US Medicaid programs. Clinicoecon Outcomes Res. 2014;6: 423–429. Copyright © 2014 Dove Medical Press.³⁷ Due to data limitations, tranexamic acid monthly probability of reintervention was assumed to be the same as those for adjunctive/alternative pharmacotherapy (ie, non-IUD hormonal therapies).

† Adjunctive/alternative pharmacotherapy comprises assorted non-IUD hormonal therapies used adjunctively after intervention/reintervention with NovaSure or other GEA or alternatively after reintervention with LNG-IUS.

Abbreviations: AUB, abnormal uterine bleeding; GEA, global endometrial ablation; IUD, intrauterine device; LNG-IUS, levonorgestrel intrauterine system; SE, standard error.

Table 3 Probabilities of intervention and reintervention complications

AUB treatment	Probability (SE) of complications following intervention	Probability (SE) of complications following reintervention
Commercial payer perspective
NovaSure	0.0325 (0.0046)	0.0325 (0.0046)
Other GEA	0.1508 (0.0018)	0.1584 (0.0081)
Hysterectomy	0.3560 (0.0033)	0.3950 (0.0056)
Tranexamic acid	–	0.1472 (0.0093)
LNG-IUS	–	0.1220 (0.0199)
Adjunctive/alternative pharmacotherapy†	–	0.1472 (0.0093)
Medicaid perspective
NovaSure	0.0325 (0.0046)	0.0325 (0.0046)
Other GEA	0.3626 (0.0155)	0.3920 (0.0437)
Hysterectomy	0.5179 (0.0164)	0.5473 (0.0284)
Tranexamic acid	–	0.3684 (0.0647)
LNG-IUS	–	0.2222 (0.1151)
Adjunctive/alternative pharmacotherapy†	–	0.3684 (0.0647)

Notes: Data from Bonafede et al;^30,31 posters (#PIH17 and #PIH22) presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 18th Annual International Meeting, May 18–22; 2013; New Orleans, LA. Available from: http://www.ispor.org/research_pdfs/43/pdffiles/PIH17.pdf and http://www.ispor.org/research_pdfs/43/pdffiles/PIH22.pdf. Data also adapted from Bonafede MM, Miller JD, Laughlin-Tommaso SK, Lukes AS, Meyer NM, Lenhart GM. Retrospective database analysis of clinical outcomes and costs for treatment of abnormal uterine bleeding among women enrolled in US Medicaid programs. Clinicoecon Outcomes Res. 2014;6:423–429. Copyright © 2014 Dove Medical Press.³⁷ Due to data limitations, values for tranexamic acid are assumed to be the same as those for adjunctive pharmacotherapy (ie, non-IUD hormonal therapies).

† Adjunctive/alternative pharmacotherapy comprises assorted non-IUD hormonal therapies used adjunctively after intervention/reintervention with NovaSure or other GEA or alternatively after reintervention with LNG-IUS.

Abbreviations: AUB, abnormal uterine bleeding; GEA, global endometrial ablation; IUD, intrauterine device; LNG-IUS, levonorgestrel intrauterine system; SE, standard error.

Table 5 Work impairment (commercial health care payer perspective)

AUB treatment	Monthly probability (SE) of absence or work loss	Annual mean days lost from work due to absence or short-term disability
Absence
Intervention
NovaSure	0.0746 (0.0109)	26.15 (0.75)
Other GEA	0.0746 (0.0109)	26.15 (0.75)
Hysterectomy	0.0765 (0.0159)	34.24 (1.49)
Reintervention
NovaSure	0.0746 (0.0109)	26.15 (0.75)
Other GEA	0.0746 (0.0109)	26.15 (0.75)
Tranexamic acid	0.0749 (0.0142)	27.52 (1.13)
LNG-IUS	0.0780 (0.0482)	22.33 (2.00)
Adjunctive/alternative pharmacotherapy†	0.0749 (0.0142)	27.52 (1.13)
Short-term disability
Intervention
NovaSure	0.0175 (0.0028)	26.97 (1.25)
Other GEA	0.0175 (0.0028)	26.97 (1.25)
Hysterectomy	0.0704 (0.0028)	28.35 (0.68)
Reintervention
NovaSure	0.0175 (0.0028)	26.97 (1.25)
Other GEA	0.0175 (0.0028)	26.97 (1.25)
Tranexamic acid	0.0214 (0.0041)	27.46 (1.44)
LNG-IUS	0.0105 (0.0097)	40.23 (8.92)
Adjunctive/alternative pharmacotherapy†	0.0214 (0.0041)	27.46 (1.44)

Notes: Data from Bonafede et al;^30,31 posters (#PIH17 and #PIH22) presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 18th Annual International Meeting, May 18-22; 2013; New Orleans, LA. Available from: http://www.ispor.org/research_pdfs/43/pdffiles/PIH17.pdf and http://www.ispor.org/research_pdfs/43/pdffiles/PIH22.pdf. Data also adapted from Bonafede MM, Miller JD, Laughlin-Tommaso SK, Lukes AS, Meyer NM, Lenhart GM. Retrospective database analysis of clinical outcomes and costs for treatment of abnormal uterine bleeding among women enrolled in US Medicaid programs. Clinicoecon Outcomes Res. 2014;6:423–429. Copyright © 2014 Dove Medical Press.³⁷ Due to data limitations, values for tranexamic acid are assumed to be the same as those for adjunctive pharmacotherapy (ie, non-IUD hormonal therapies).

† Adjunctive/alternative pharmacotherapy comprises assorted non-IUD hormonal therapies used adjunctively after intervention/reintervention with NovaSure or other GEA or alternatively after reintervention with LNG-IUS.

Abbreviations: AUB, abnormal uterine bleeding; GEA, global endometrial ablation; IUD, intrauterine device; LNG-IUS, levonorgestrel intrauterine system; SE, standard error.

Table 7 Cost-effectiveness analysis results

Model scenario and perspective	Economic outcomes		Clinical and work impairment outcomes					Incremental cost-effectiveness ratios
	Direct costs*	Indirect costs*,†	QALYs	Complications	Reinterventions	Reintervention hysterectomies	Work days lost‡	Direct cost/QALY	Direct cost/complication, direct cost/reintervention§, and direct cost/reintervention hysterectomies§	Total direct and indirect cost/work days saved||
Commercial payer perspective
1-Year scenario
NovaSure	$6,602	$7,412	0.819	0.043	0.031	0.027	29.4	–	–	–
Other GEA	$7,180	$7,491	0.815	0.171	0.057	0.049	29.7	NovaSure dominates other GEA¶	NovaSure dominates other GEA¶	NovaSure dominates other GEA¶
Hysterectomy	$13,221	$13,924	0.800	0.356	N/A	N/A	55.3	NovaSure dominates hysterectomy¶	NovaSure dominateshysterectomy¶	NovaSure dominates hysterectomy¶
3-Year scenario
NovaSure	$7,377	$8,016	2.397	0.053	0.059	0.051	31.9	–	–	–
Other GEA	$8,308	$8,577	2.394	0.189	0.106	0.093	34.2	NovaSure dominates other GEA¶	NovaSure dominates other GEA¶	NovaSure dominates other GEA¶
Hysterectomy	$13,840	$13,924	2.451	0.356	N/A	N/A	55.3	$118,846 saved/QALY lost#	NovaSure dominates hysterectomy¶	NovaSure dominates hysterectomy¶
5-Year scenario
NovaSure	$8,213	$8,583	3.877	0.066	0.094	0.082	34.4	–	–	–
Other GEA	$9,522	$9,549	3.877	0.211	0.166	0.144	38.5	NovaSure dominates other GEA¶	NovaSure dominates other GEA¶	NovaSure dominates other GEA¶
Hysterectomy	$14,421	$13,924	3.999	0.356	N/A	N/A	55.3	$51,123 saved/QALY lost#	NovaSure dominates hysterectomy¶	NovaSure dominates hysterectomy¶
Medicaid payer perspective
1-Year scenario
NovaSure	$4,419	N/A	0.819	0.049	0.033	0.029	N/A	–	–	–
Other GEA	$6,158	N/A	0.808	0.422	0.113	0.098	N/A	NovaSure dominates other GEA¶	NovaSure dominates other GEA¶	N/A
Hysterectomy	$12,716	N/A	0.792	0.518	N/A	N/A	N/A	NovaSure dominates hysterectomy¶	NovaSure dominates hysterectomy¶	N/A
3-Year scenario
NovaSure	$5,352	N/A	2.396	0.063	0.062	0.054	N/A	–	–	–
Other GEA	$8,392	N/A	2.387	0.471	0.207	0.181	N/A	NovaSure dominates other GEA¶	NovaSure dominates other GEA¶	N/A
Hysterectomy	$14,227	N/A	2.444	0.518	N/A	N/A	N/A	$187,884 saved/QALY lost#	NovaSure dominates hysterectomy¶	N/A
5-Year scenario
NovaSure	$6,383	N/A	3.876	0.081	0.098	0.085	N/A	–	–	–
Other GEA	$10,755	N/A	3.874	0.526	0.313	0.270	N/A	NovaSure dominates other GEA¶	NovaSure dominates other GEA¶	N/A
Hysterectomy	$15,642	N/A	3.991	0.518	N/A	N/A	N/A	$80,902 saved/QALY lost#	NovaSure dominates hysterectomy¶	N/A

Notes:

* All costs in 2013 US dollars.

† Indirect costs are attributable to work absence and STD leave.

‡ Combined number of days lost from work due to absence and from STD leave.

§ NOT applicable to NovaSure versus hysterectomy.

|| Work day not lost due to absence or STD.

¶ “NovaSure dominates” denotes that NovaSure confers better outcomes (ie, greater QALYs, fewer complications, or fewer work days lost) at lower cost compared with other GEA or hysterectomy; therefore, a numerical ICER is not calculated.

# NovaSure confers cost savings but with reduced benefits; acceptability of decremental cost effectiveness is subjective.

Abbreviations: ICER, incremental cost-effectiveness ratio; N/A, not applicable to the Medicaid payer perspective; other GEA, global endometrial ablation techniques other than NovaSure; QALY, quality-adjusted life year; STD, short-term disability.

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