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

Maria C. Breijer*, Helena C. Van Doorn, T. Justin Clark, Khalid S. Khan, Anne Timmermans, Ben W.J. Mol, Brent C. Opmeer

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)91-96
Number of pages6
JournalEuropean Journal of Obstetrics and Gynecology and Reproductive Biology
Volume163
Issue number1
DOIs
Publication statusPublished - Jul 2012

Keywords

  • Cost-effectiveness
  • Decision analysis
  • Endometrial carcinoma
  • Postmenopausal bleeding

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