Cost-effectiveness analysis of endometrial cancer prevention strategies for obese women.
OBJECTIVE
It is unknown whether obese women would benefit from oral contraceptives or screening as endometrial cancer prevention strategies. We estimated the net health benefits and cost-effectiveness of these strategies in a hypothetical cohort of obese women.


METHODS
A Markov decision-analytic model evaluated 4 strategies: 1) no prevention (reference strategy); 2) oral contraceptive pills (OCPs) for 5 years; 3) annual screening with endometrial biopsy from age 30; 4) biennial screening from age 30. Net health benefit was life expectancy and primary outcome was the incremental cost-effectiveness ratio. Baseline and transition probabilities were obtained from published literature and the Surveillance Epidemiology and End Results database, and costs were from the U.S. Department of Health and Human Services and Agency for Healthcare Research and Quality. Sensitivity analyses were performed for uncertainty around various measures.


RESULTS
Average life expectancy for all strategies ranged from 74.52 to 74.60 years. None of the strategies had an incremental cost-effectiveness ratio less than $50,000 per year of life saved relative to the next best strategy. Endometrial cancer risk in obese women had to be 13 times greater than the general population risk before OCPs were a cost-effective intervention.


CONCLUSIONS
Oral contraceptives and current screening methods are not cost-effective endometrial cancer prevention strategies for obese women. Risk factors such as morbid obesity and longstanding anovulation may define a subgroup at highest risk of endometrial cancer for whom OCPs may be a cost-effective strategy. Interventions that reduce endometrial cancer risk further or those with additional health benefits are needed in this population.


METHODS
III.
Kwon
Janice S
JS
Department of Gynecologic Oncology, MD Anderson Cancer Center, Houston, TX, USA. jskwon@mdanderson.org
Lu
Karen H
KH
D000328:Adult; D000368:Aged; D001706:Biopsy / Q000191:economics; D003278:Contraceptives, Oral, Hormonal / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis / Q000379:methods; D016889:Endometrial Neoplasms / Q000150:complications / Q000191:economics* / Q000517:prevention & control*; D004717:Endometrium / Q000473:pathology; D005260:Female; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000191:economics
D003278:Contraceptives, Oral, Hormonal