Diagnostic strategies for endometrial cancer in women with postmenopausal bleeding: cost-effectiveness of individualized strategies

Eur J Obstet Gynecol Reprod Biol. 2012 Jul;163(1):91-6. doi: 10.1016/j.ejogrb.2012.03.025. Epub 2012 Apr 13.

Abstract

Objective: To evaluate the cost-effectiveness of diagnostic strategies incorporating the diagnostic value of patient characteristics for endometrial carcinoma using prediction models.

Study design: A decision analytic model was created to compare four diagnostic strategies for women with postmenopausal bleeding: the main outcome measures were 5 year survival, costs, and cost-effectiveness of three model based strategies compared to the strategy reflecting current practice.

Results: A strategy selecting women for endometrial biopsy based on their history only, dominated all other strategies (more effective, less cost). In a clinical scenario where transvaginal sonography (TVS) was assumed to be an integral part of the consultation without additional costs, a strategy selecting high-risk women for TVS became the most cost-effective strategy.

Conclusions: Strategies taking into account the individual probability based on a prognostic model are less costly than the currently applied strategy for a similar effectiveness. The most cost-effective strategy depends on the clinical setting: in areas where TVS is performed by the consulting gynecologist without extra costs, selective TVS based on history is the most cost-effective strategy. When TVS is not readily available and therefore incurs extra costs, a risk selection based on patient characteristics is most cost-effective.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biopsy / economics
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Diabetes Complications
  • Endometrial Neoplasms / diagnosis*
  • Endometrial Neoplasms / diagnostic imaging
  • Endometrial Neoplasms / economics
  • Endometrium / diagnostic imaging
  • Female
  • Humans
  • Middle Aged
  • Obesity / complications
  • Postmenopause
  • Ultrasonography / economics
  • Uterine Hemorrhage / diagnosis*
  • Uterine Hemorrhage / diagnostic imaging
  • Uterine Hemorrhage / economics