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.

Cost-effectiveness, Decision analysis, Endometrial carcinoma, Postmenopausal bleeding
dx.doi.org/10.1016/j.ejogrb.2012.03.025, hdl.handle.net/1765/64611
European Journal of Obstetrics & Gynecology and Reproductive Biology
Department of Gynaecology & Obstetrics

Breijer, M.C, van Doorn, H.C, Clark, T.J, Khan, K.S, Timmermans, A, Mol, B.W.J, & Opmeer, B.C. (2012). Diagnostic strategies for endometrial cancer in women with postmenopausal bleeding: Cost-effectiveness of individualized strategies. European Journal of Obstetrics & Gynecology and Reproductive Biology, 163(1), 91–96. doi:10.1016/j.ejogrb.2012.03.025