title: Diagnostic strategies for endometrial cancer in women with postmenopausal bleeding: cost-effectiveness of individualized strategies.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of diagnostic strategies incorporating the diagnostic value of patient characteristics for endometrial carcinoma using prediction models.
  
  
  METHODS
  A decision analytic model was created to compare four diagnostic strategies for women with postmenopausal bleeding: the main outcome measures were 5 year survival, costs, and cost-effectiveness of three model based strategies compared to the strategy reflecting current practice.
  
  
  RESULTS
  A strategy selecting women for endometrial biopsy based on their history only, dominated all other strategies (more effective, less cost). In a clinical scenario where transvaginal sonography (TVS) was assumed to be an integral part of the consultation without additional costs, a strategy selecting high-risk women for TVS became the most cost-effective strategy.
  
  
  CONCLUSIONS
  Strategies taking into account the individual probability based on a prognostic model are less costly than the currently applied strategy for a similar effectiveness. The most cost-effective strategy depends on the clinical setting: in areas where TVS is performed by the consulting gynecologist without extra costs, selective TVS based on history is the most cost-effective strategy. When TVS is not readily available and therefore incurs extra costs, a risk selection based on patient characteristics is most cost-effective.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands. m.c.breijer@amc.uva.nl
authors.forename: Maria C
authors.initials: MC
authors.lastname: Breijer
authors.forename: Helena C
authors.initials: HC
authors.lastname: Van Doorn
authors.forename: T Justin
authors.initials: TJ
authors.lastname: Clark
authors.forename: Khalid S
authors.initials: KS
authors.lastname: Khan
authors.forename: Anne
authors.initials: A
authors.lastname: Timmermans
authors.forename: Ben W J
authors.initials: BW
authors.lastname: Mol
authors.forename: Brent C
authors.initials: BC
authors.lastname: Opmeer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D048909:Diabetes Complications; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics; D004717:Endometrium / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D017698:Postmenopause; D014463:Ultrasonography / Q000191:economics; D014592:Uterine Hemorrhage / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics