Cost Analysis Model: US versus Endometrial Biopsy in Evaluation of Peri- and Postmenopausal Abnormal Vaginal Bleeding

Abstract

Transvaginal US-initiated triage predicts substantial cost savings versus biopsy-based algorithms in evaluating typical populations of peri- and postmenopausal women with abnormal vaginal bleeding seen in clinical practice.

Cost-effectiveness of diagnostic strategies for the management of abnormal uterine bleeding (heavy menstrual bleeding and post-menopausal bleeding): a decision analysis

“…One hundred and four articles were identified once duplicates had been removed, and four of these were selected as being relevant. 29,69,70,82 One of these was the analysis performed alongside a RCT which has been appraised in the HMB section of this introduction. 29 The other three studies were based upon economic modelling.…”

“…29 The other three studies were based upon economic modelling. 69,70,82 The RCT which looked at cost-effectiveness compared three outpatient diagnostic tests (outpatient biopsy, ultrasound and hysteroscopy) for the evaluation of AUB in certain test combinations. 29 The effectiveness BACKGROUND outcome measure was 'need for no further tests'.…”

“…The three economic modelling analysis were based upon three different health-care systems, with one study being from the USA, 82 one from the Netherlands 70 and the final one from the UK. 69 The US study 82 used a decision-analytic model to evaluate six diagnostic strategies to diagnose pathology in women with peri-and post-menopausal women, with the aim of determining whether initial diagnosis with EBx or TVS minimises cost.…”

“…69 The US study 82 used a decision-analytic model to evaluate six diagnostic strategies to diagnose pathology in women with peri-and post-menopausal women, with the aim of determining whether initial diagnosis with EBx or TVS minimises cost. 82 The six strategies started with EBx or TVS and added in additional testing with hysteroscopy, biopsy (if TVS was used initially) or SIS until a diagnosis was reached or bleeding was resolved. HRT was used as a treatment for 3 months if the biopsy was negative or if the TVS showed no treatable pathology with an endometrial thickness of less than 5 mm.…”

The use of new and old ultrasound techniques in the assessment of women with postmenopausal bleeding

“…Therefore, all women presenting with PMB should undergo evaluation with transvaginal ultrasound to estimate the risk of endometrial cancer, and speculum examination/cervical cytology to rule out cervical pathology. Management strategies using ultrasound as the primary investigation tool have been shown to be more cost effective than those using endometrial biopsy for the investigation of PMB 1 . In women with PMB, the primary aim is to estimate the risk of endometrial cancer, since women at low risk of cancer can be managed expectantly, whereas women at high risk must undergo endometrial biopsy.…”