Cost-effectiveness analysis of annual screening strategies for endometrial cancer.
OBJECTIVE
The objective of the study was to determine the cost-effectiveness of annual screening tests for endometrial cancer.


METHODS
Markov state transition model of the natural history of endometrial cancer used as the design for the study. Incidence was modeled for the general population and high risk groups (obese, body mass index [BMI] of >or= 30 kg/m(2); tamoxifen users). Strategies evaluated were no screening, annual endometrial biopsy, annual endovaginal ultrasound, and annual serum screening. Serum screening was based on a recently described biomarker panel (sensitivity of 0.98, specificity of 0.98).


RESULTS
In the general population model, no screening was least expensive, whereas annual serum screening age at 50-75 years had incremental cost-effectiveness ratio (ICER) of $60,363 per year of life saved (YLS) compared with no screening. In a high-risk population (obesity, BMI of >or= 30 kg/m(2)), annual serum screening at age 45-80 years had ICER of $41,226 per YLS compared with no screening. Annual endometrial biopsy and annual transvaginal ultrasound were dominated.


CONCLUSIONS
Annual serum screening for endometrial cancer has the potential to be cost effective when applied to high-risk populations.
Havrilesky
Laura J
LJ
Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC 27710, USA. havri001@mc.duke.edu
Maxwell
G Larry
GL
Myers
Evan R
ER
D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D016889:Endometrial Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D008875:Middle Aged