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Eur J Obstet Gynecol Reprod Biol. 2012 Jul;163(1):91-6. doi: 10.1016/j.ejogrb.2012.03.025. Epub 2012 Apr 13.

Diagnostic strategies for endometrial cancer in women with postmenopausal bleeding: cost-effectiveness of individualized strategies.

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  • 1Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands.



To evaluate the cost-effectiveness of diagnostic strategies incorporating the diagnostic value of patient characteristics for endometrial carcinoma using prediction models.


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.


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.


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.

Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

[PubMed - indexed for MEDLINE]
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