Abstract
Objective. To evaluate whether a model to predict a failed endometrial biopsy in women with postmenopausal bleeding (PMB) and a thickened endometrium can reduce costs without compromising diagnostic accuracy. Design, Setting, and Population. Model based cost-minimization analysis. Methods. A decision analytic model was designed to compare two diagnostic strategies for women with PMB: (I) attempting office endometrial biopsy and performing outpatient hysteroscopy after failed biopsy and (II) predicted probability of a failed endometrial biopsy based on patient characteristics to guide the decision for endometrial biopsy or immediate hysteroscopy. Robustness of assumptions regarding costs was evaluated in sensitivity analyses. Main Outcome Measures. Costs for the different strategies. Results. At different cut-offs for the predicted probability of failure of an endometrial biopsy, strategy I was generally less expensive than strategy II. The costs for strategy I were always € 460; the costs for strategy II varied between € 457 and € 475. At a 65% cut-off, a possible saving of € 3 per woman could be achieved. Conclusions. Individualizing the decision to perform an endometrial biopsy or immediate hysteroscopy in women presenting with postmenopausal bleeding based on patient characteristics does not increase the efficiency of the diagnostic work-up.
Highlights
Postmenopausal bleeding (PMB) is the most common presenting symptom of endometrial cancer and warrants further investigation [1]
We described a multivariable prediction model to predict the probability of a failed endometrial biopsy in women with PMB [15]
This decision was based on the probability of a failed endometrial biopsy, estimated with a clinical prediction model based on patient characteristics
Summary
Postmenopausal bleeding (PMB) is the most common presenting symptom of endometrial cancer and warrants further investigation [1]. Since the 1990s, endometrial thickness measured by transvaginal ultrasound was introduced to select women for further invasive diagnostic testing to detect or rule out endometrial cancer [2,3,4]. The optimal endometrial thickness cut-off for women with PMB still remains questionable, at present most guidelines advise an endometrial thickness cut-off of 4 or 5 mm to select patients for further histological verification [1, 5,6,7,8,9,10]. A strategy with endometrial biopsy after endometrial thickness measurement is the most cost-effective diagnostic strategy for patients with PMB [12]
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