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https://hdl.handle.net/2440/84740
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Type: | Journal article |
Title: | Diagnostic strategies for endometrial cancer in women with postmenopausal bleeding: cost-effectiveness of individualized strategies |
Author: | Breijer, M. van Doorn, H. Clark, T. Khan, K. Timmermans, A. Mol, B. Opmeer, B. |
Citation: | European Journal of Obstetrics Gynecology and Reproductive Biology, 2012; 163(1):91-96 |
Publisher: | Elsevier Ireland |
Issue Date: | 2012 |
ISSN: | 0301-2115 1872-7654 |
Statement of Responsibility: | Maria C. Breijer, Helena C. Van Doorn, T. Justin Clark, Khalid S. Khan, Anne Timmermans, Ben W.J. Mol, Brent C. Opmeer |
Abstract: | <h4>Objective</h4>To evaluate the cost-effectiveness of diagnostic strategies incorporating the diagnostic value of patient characteristics for endometrial carcinoma using prediction models.<h4>Study design</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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. |
Keywords: | Cost-effectiveness; Decision analysis; Endometrial carcinoma; Postmenopausal bleeding |
Rights: | Copyright © 2012 Elsevier Ireland Ltd. All rights reserved. |
DOI: | 10.1016/j.ejogrb.2012.03.025 |
Published version: | http://dx.doi.org/10.1016/j.ejogrb.2012.03.025 |
Appears in Collections: | Aurora harvest 7 Obstetrics and Gynaecology publications |
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