title: Vaginal ultrasonography versus endometrial biopsy in women with postmenopausal bleeding.
abstract: OBJECTIVE
  Our goal was to compare the predicted outcomes and costs of two diagnostic algorithms for postmenopausal bleeding.
  
  
  METHODS
  Two algorithms for postmenopausal bleeding were developed, one with vaginal ultrasonography and the other with office endometrial biopsy as the first test. Literature review was performed to estimate the probability of either an abnormal result of ultrasonography or a nondiagnostic biopsy, or both. Cost and sensitivity analyses were performed.
  
  
  RESULTS
  Estimated probability of a nondiagnostic endometrial biopsy was 28%, and estimated probability of an abnormal result of vaginal ultrasonography (either inconclusive or endometrial thickness > 4 mm) was 55%. Cost analysis showed that vaginal ultrasonography as the first diagnostic test cost $230 per patient on average compared with $244 for endometrial biopsy, with savings ranging from $14 to $20 per patient over a wide range of possible values for estimated parameters.
  
  
  CONCLUSIONS
  Vaginal ultrasonography costs slightly less than office endometrial biopsy as the first test in the diagnostic evaluation of women with postmenopausal bleeding.
authors.affiliation: Department of Gynecology and Obstetrics, Cleveland Clinic Foundation, OH 44195, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Weber
authors.forename: J L
authors.initials: JL
authors.lastname: Belinson
authors.forename: L D
authors.initials: LD
authors.lastname: Bradley
authors.forename: M R
authors.initials: MR
authors.lastname: Piedmonte
mesh_terms: D000465:Algorithms; D001706:Biopsy / Q000191:economics; D003365:Costs and Cost Analysis; D004717:Endometrium / Q000473:pathology*; D005260:Female; D006801:Humans; D016239:MEDLINE; D017063:Outcome Assessment, Health Care / Q000191:economics*; D017698:Postmenopause; D014463:Ultrasonography / Q000191:economics; D014481:United States; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging* / Q000473:pathology*; D014621:Vagina