title: Does probability guided hysteroscopy reduce costs in women investigated for postmenopausal bleeding?
abstract: OBJECTIVE
  To evaluate whether a model to predict a failed endometrial biopsy in women with postmenopausal bleeding (PMB) and a thickened endometrium can reduce costs without compromising diagnostic accuracy.
  
  
  METHODS
  Model based cost-minimization analysis.
  
  
  METHODS
  A decision analytic model was designed to compare two diagnostic strategies for women with PMB: (I) attempting office endometrial biopsy and performing outpatient hysteroscopy after failed biopsy and (II) predicted probability of a failed endometrial biopsy based on patient characteristics to guide the decision for endometrial biopsy or immediate hysteroscopy. Robustness of assumptions regarding costs was evaluated in sensitivity analyses.
  
  
  METHODS
  Costs for the different strategies.
  
  
  RESULTS
  At different cut-offs for the predicted probability of failure of an endometrial biopsy, strategy I was generally less expensive than strategy II. The costs for strategy I were always € 460; the costs for strategy II varied between € 457 and € 475. At a 65% cut-off, a possible saving of € 3 per woman could be achieved.
  
  
  CONCLUSIONS
  Individualizing the decision to perform an endometrial biopsy or immediate hysteroscopy in women presenting with postmenopausal bleeding based on patient characteristics does not increase the efficiency of the diagnostic work-up.
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands ; Department of Obstetrics and Gynecology, Erasmus Medical Center, 's Gravendijkwal 230, 3015 CE Rotterdam, Netherlands.
authors.forename: M C
authors.initials: MC
authors.lastname: Breijer
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands ; Department of Obstetrics and Gynecology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: van Hanegem
authors.affiliation: Department of Pathology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, Netherlands.
authors.forename: N C M
authors.initials: NC
authors.lastname: Visser
authors.affiliation: Division of Women and Baby, Gynecological Oncology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.
authors.forename: R H M
authors.initials: RH
authors.lastname: Verheijen
authors.affiliation: The Robinson Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Level 3, Medical School South, Frome Road, Adelaide, SA 5005, Australia.
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Obstetrics and Gynecology, TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD Tilburg, Netherlands.
authors.forename: J M A
authors.initials: JM
authors.lastname: Pijnenborg
authors.affiliation: Clinical Research Unit, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
authors.forename: B C
authors.initials: BC
authors.lastname: Opmeer
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Timmermans
mesh_terms: D000368:Aged; D001706:Biopsy / Q000191:economics / Q000379:methods; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D003951:Diagnostic Errors; D016889:Endometrial Neoplasms / Q000175:diagnosis; D004717:Endometrium; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000191:economics* / Q000379:methods*; D008875:Middle Aged; D017698:Postmenopause; D011336:Probability; D014592:Uterine Hemorrhage / Q000175:diagnosis*