Does Probability Guided Hysteroscopy Reduce Costs in Women Investigated for Postmenopausal Bleeding?
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. Design, Setting, and Population. Model based cost-minimization analysis. Methods. A decisio...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2015-01-01
|
| Series: | The Scientific World Journal |
| Online Access: | http://dx.doi.org/10.1155/2015/605312 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832565605864046592 |
|---|---|
| author | M. C. Breijer N. van Hanegem N. C. M. Visser R. H. M. Verheijen B. W. J. Mol J. M. A. Pijnenborg B. C. Opmeer A. Timmermans |
| author_facet | M. C. Breijer N. van Hanegem N. C. M. Visser R. H. M. Verheijen B. W. J. Mol J. M. A. Pijnenborg B. C. Opmeer A. Timmermans |
| author_sort | M. C. Breijer |
| collection | DOAJ |
| description | 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. Design, Setting, and Population. 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. Main Outcome Measures. 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. |
| format | Article |
| id | doaj-art-c2ad6624e99241d9b23b75eecbb95c02 |
| institution | Kabale University |
| issn | 2356-6140 1537-744X |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | The Scientific World Journal |
| spelling | doaj-art-c2ad6624e99241d9b23b75eecbb95c022025-02-03T01:07:13ZengWileyThe Scientific World Journal2356-61401537-744X2015-01-01201510.1155/2015/605312605312Does Probability Guided Hysteroscopy Reduce Costs in Women Investigated for Postmenopausal Bleeding?M. C. Breijer0N. van Hanegem1N. C. M. Visser2R. H. M. Verheijen3B. W. J. Mol4J. M. A. Pijnenborg5B. C. Opmeer6A. Timmermans7Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, NetherlandsDepartment of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, NetherlandsDepartment of Pathology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, NetherlandsDivision of Women and Baby, Gynecological Oncology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, NetherlandsThe Robinson Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Level 3, Medical School South, Frome Road, Adelaide, SA 5005, AustraliaDepartment of Obstetrics and Gynecology, TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD Tilburg, NetherlandsClinical Research Unit, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, NetherlandsDepartment of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, NetherlandsObjective. 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. Design, Setting, and Population. 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. Main Outcome Measures. 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.http://dx.doi.org/10.1155/2015/605312 |
| spellingShingle | M. C. Breijer N. van Hanegem N. C. M. Visser R. H. M. Verheijen B. W. J. Mol J. M. A. Pijnenborg B. C. Opmeer A. Timmermans Does Probability Guided Hysteroscopy Reduce Costs in Women Investigated for Postmenopausal Bleeding? The Scientific World Journal |
| title | Does Probability Guided Hysteroscopy Reduce Costs in Women Investigated for Postmenopausal Bleeding? |
| title_full | Does Probability Guided Hysteroscopy Reduce Costs in Women Investigated for Postmenopausal Bleeding? |
| title_fullStr | Does Probability Guided Hysteroscopy Reduce Costs in Women Investigated for Postmenopausal Bleeding? |
| title_full_unstemmed | Does Probability Guided Hysteroscopy Reduce Costs in Women Investigated for Postmenopausal Bleeding? |
| title_short | Does Probability Guided Hysteroscopy Reduce Costs in Women Investigated for Postmenopausal Bleeding? |
| title_sort | does probability guided hysteroscopy reduce costs in women investigated for postmenopausal bleeding |
| url | http://dx.doi.org/10.1155/2015/605312 |
| work_keys_str_mv | AT mcbreijer doesprobabilityguidedhysteroscopyreducecostsinwomeninvestigatedforpostmenopausalbleeding AT nvanhanegem doesprobabilityguidedhysteroscopyreducecostsinwomeninvestigatedforpostmenopausalbleeding AT ncmvisser doesprobabilityguidedhysteroscopyreducecostsinwomeninvestigatedforpostmenopausalbleeding AT rhmverheijen doesprobabilityguidedhysteroscopyreducecostsinwomeninvestigatedforpostmenopausalbleeding AT bwjmol doesprobabilityguidedhysteroscopyreducecostsinwomeninvestigatedforpostmenopausalbleeding AT jmapijnenborg doesprobabilityguidedhysteroscopyreducecostsinwomeninvestigatedforpostmenopausalbleeding AT bcopmeer doesprobabilityguidedhysteroscopyreducecostsinwomeninvestigatedforpostmenopausalbleeding AT atimmermans doesprobabilityguidedhysteroscopyreducecostsinwomeninvestigatedforpostmenopausalbleeding |