Diagnostic strategies for endometrial cancer in women with postmenopausal bleeding: cost-effectiveness of individualized strategies
European Journal of Obstetrics & Gynecology and Reproductive Biology, 06/14/2012
Breijer MC et al. – 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.Methods
- 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.
- 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.