An assessment of economic measures used in menorrhagia: a systematic review

'Menorrhagia', or heavy menstrual bleeding, is a common problem affecting women. The principal driver for treatment is women's experience of its interference in their lives, so a measure of quality of life (QoL) is increasingly used as the primary outcome to assess treatment success. QoL measures need to accurately reflect women's concerns as these measures are often used to inform resource allocation decisions within the healthcare service. Healthcare decision-makers often advocate the use of generic measures so as to achieve consistency when making decisions. Generic measures, by definition, have a broad focus on QoL in contrast to disease-specific measures that focus on dimensions of health relevant to the condition. We report a systematic review of studies that have either used or assessed economic outcome measures in menorrhagia, and present criteria for assessing which measure is the most appropriate. Studies including women presenting with menorrhagia, and using or assessing economic measures were sought by searching nine electronic databases. Fifty-six eligible studies were identified. A narrative synthesis was most suitable to the review question. Eleven studies assessed the psychometric properties of the outcome measures, twelve studies applied the measures in an economic evaluation, and thirty-three used them in effectiveness studies. Mixed results on the psychometric properties of the instruments were observed. Studies were often found to include both a disease-specific and a generic measure. We found no consensus on the most appropriate economic outcome measure to use when assessing the cost-effectiveness of treatment for menorrhagia. This is an important finding as QoL is the primary focus for treatment decisions. The cyclical nature of the condition has a large impact on the reliability and validity of outcome measurement. Alternative measures, such as willingness-to-pay, which embrace more than health and avoid standard recall periods should be explored.