Page 40 - EVALUATION OF TREATMENT FOR HEAVY MENSTRUAL BLEEDING by Herman, Malou

Chapter 9
characteristics that are typical for endometrial ablation, women were prepared to trade off their preference.
Is there a relation between the Pictorial Blood Assessment Chart score and treatment outcome?
The Pictorial Blood Assessment Chart (PBAC) is a semi-quantitative measurement and is validated to diagnose HMB. Although 150 points is often used as a frequently chosen cut-off point to diagnose HMB, it was uncertain whether women would be satisfied with a score just below 150 points after treatment. Chapter 7 focuses on the meaning of the PBAC score after treatment and its relation with the outcome after endometrial ablation. The Birmingham Clinical Trials Unit group created a database consisting of individual patient data (IPD) of randomised controlled trials (RCT) regarding second-generation endometrial ablation for HMB. We used the raw IPD of these studies. Nine trials met our inclusion criteria and were included in this study. In total these nine trials report on the individual data of 900 women. We compared the PBAC scores and measures of effectiveness. Effectiveness was measured as satisfaction with the treatment effect (yes/no) or surgical re- intervention (yes/no). The median PBAC score at 12 months was 7 points (range 0-2500). The overall satisfaction rate was 89% and the overall re-intervention rate was 7%. A clear association was found between the PBAC at 12 months follow-up and satisfaction (OR 0.16, 95% CI 0.11-0.24) and surgical re-intervention (OR 2.3, 95% CI 1.8-2.8). PBAC decrease was also associated with satisfaction (OR 2.0, 95% CI 1.7-2.3) and surgical re-intervention (OR 0.69, 95%CI 0.63-0.75). PBAC scores at 12 months that corresponded best with satisfaction occurred at 59 points, which means a decrease of around 90% in PBAC score. On the other hand, most women who are unsatisfied have a reduction of less than 80% or a PBAC score higher than 80 points (sensitivity scores >90%).The PBAC cut-off point for re-intervention occurred at 98 points or a decrease of less than 75% in score.
What outcome measures are used in heavy menstrual bleeding studies?
Chapter 8 analyses the chosen primary outcomes and measurement tools used in HMB research.
Heavy menstrual bleeding (HMB) is a common problem with a variety of treatment options and many studies have been performed evaluating treatment effects.
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