title: Cost-effectiveness of endometrial evaluation prior to morcellation in surgical procedures for prolapse.
abstract: OBJECTIVE
  The objective of the study was to compare the cost-effectiveness of 3 screening options for endometrial cancer in asymptomatic, postmenopausal women prior to undergoing morcellation in minimally invasive supracervical hysterectomy and minimally invasive sacral colpopexy for the treatment of pelvic organ prolapse.
  
  
  METHODS
  A decision tree model was constructed to compare no screening, endometrial biopsy, and transvaginal ultrasound for asymptomatic, postmenopausal women prior to surgery. Effectiveness was measured by life-years. The incremental cost-effectiveness ratio, defined as the difference in cost between 2 screening options divided by the difference in life-years between the 2 options, was calculated in 2012 US dollars for endometrial biopsy and transvaginal ultrasound, in comparison with no screening.
  
  
  RESULTS
  Using an endometrial cancer prevalence of 0.6% and a 40% risk of upstaging after morcellation, the expected per-patient cost was $8800, $9023, and $9112 over 5 years for no screening, endometrial biopsy, and transvaginal ultrasound, respectively. The expected life-years saved compared with no screening were 0.00108 for endometrial biopsy and 0.00105 for transvaginal ultrasound, ie, 0.39 and 0.38 days, respectively. The estimated incremental cost-effectiveness ratio was $207,348 for endometrial biopsy and $298,038 for transvaginal ultrasound compared with no screening. A sensitivity analysis showed that the prevalence of endometrial cancer and the risk of endometrial cancer upstaging after morcellation had the greatest impact on the cost-effectiveness of screening.
  
  
  CONCLUSIONS
  For asymptomatic, postmenopausal women, preoperative endometrial evaluation via endometrial biopsy or transvaginal ultrasound helps improve the preoperative detection of endometrial cancer, but universal screening is not cost effective.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT. Electronic address: alexandra.mcpencow@yale.edu.
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: McPencow
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Erekson
authors.forename: Marsha K
authors.initials: MK
authors.lastname: Guess
authors.forename: Deanna K
authors.initials: DK
authors.lastname: Martin
authors.forename: Divya A
authors.initials: DA
authors.lastname: Patel
authors.forename: Xiao
authors.initials: X
authors.lastname: Xu
mesh_terms: D001706:Biopsy / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000191:economics / Q000379:methods
keywords: preoperative endometrial evaluation; uterine morcellation