title: Cost-effectiveness of routine vaginal cytology for endometrial cancer surveillance.
abstract: OBJECTIVE
  To examine the cost-effectiveness of routine vaginal cytology in detecting asymptomatic isolated vaginal recurrence during post-treatment endometrial cancer surveillance.
  
  
  METHODS
  All patients treated for endometrial cancer between 7/1/97 and 6/30/2005 were retrospectively identified from the tumor registry database. Clinico-pathologic characteristics and surveillance testing data were abstracted from medical records. The total number of Pap tests performed during surveillance or until the time of recurrence was calculated and charges associated with detecting asymptomatic isolated vaginal recurrence assigned based on 2005 Pap test costs adjusted retroactively using the consumer price index.
  
  
  RESULTS
  Three hundred seventy-seven patients met inclusion criteria: FIGO Stage I=63.7%, Stage II=10.1%, Stage III=18.8%, Stage IV=7.4%. The median follow-up time was 30.4 months. A total of 2,134 Pap tests were collected during the study interval (median 5, mean 5.76 samples/patient). Endometrial cancer recurred in 61 patients (16.2%); 11 patients (2.9%) had an isolated vaginal recurrence. Seven isolated vaginal recurrences were detected by physical examination alone, and 2 were detected by interval computed tomography. An asymptomatic isolated vaginal recurrence was detected by routine vaginal cytology in 2 of 377 patients (0.5%). Detection of each asymptomatic vaginal recurrence required 1067 Pap tests, generating 44,049 US dollar in cumulative charges.
  
  
  CONCLUSIONS
  As a surveillance test for endometrial cancer recurrence, routine vaginal cytology is costly, inefficient, and benefits less than 1% of patients. Elimination or reduction in the use of vaginal cytology for this purpose offers an opportunity for significant cost savings in gynecologic oncology health care expenditure.
authors.affiliation: The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. rbristo@jhmi.edu
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
authors.forename: Scott C
authors.initials: SC
authors.lastname: Purinton
authors.forename: Antonio
authors.initials: A
authors.lastname: Santillan
authors.forename: Teresa P
authors.initials: TP
authors.lastname: Diaz-Montes
authors.forename: Ginger J
authors.initials: GJ
authors.lastname: Gardner
authors.forename: Robert L
authors.initials: RL
authors.lastname: Giuntoli
mesh_terms: D003362:Cost-Benefit Analysis; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000473:pathology; D005260:Female; D017048:Health Care Costs; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000191:economics* / Q000473:pathology; D009367:Neoplasm Staging; D014626:Vaginal Smears / Q000191:economics