Cost-effectiveness of the use of transvaginal sonography in the evaluation of postmenopausal bleeding

F. Paul H.L.J. Dijkhuizen, Ben W.J. Mol, Hans A.M. Brölmann, A. Peter M. Heintz

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Objectives: To assess the cost-effectiveness of transvaginal sonography (TVS) in the diagnostic work-up of women with postmenopausal bleeding. Methods: We performed a decision analysis in which we estimated life expectancy and cost of four strategies for the evaluation of postmenopausal bleeding: TVS (I), TVS and office endometrial biopsy (II), TVS and hysteroscopy (III), and endometrial biopsy (IV). In strategies incorporating TVS, calculations were performed for three different cut-off values between 3 and 9 mm double layer. Expectant management, i.e. no diagnosis or treatment was considered to be the reference strategy to which the other four strategies were compared. Data were obtained from the published literature. In extensive sensitivity analyses, we varied patient's age, discount rate, prevalence of endometrial carcinoma and atypical hyperplasia, and costs. Results: The strategy with endometrial biopsy and the strategy with TVS followed by endometrial biopsy in case of an increased endometrial thickness were the most cost-effective strategies. The strategy starting with endometrial biopsy was the most cost-effective when the prevalence of endometrial carcinoma was ≥15.3%, whereas the strategy with TVS and endometrial biopsy was the most cost-effective for women in which the prevalence of endometrial carcinoma was lower. In these strategies, a cut-off level for abnormality of 9 mm resulted in lowest cost per life-year gained. Conclusions: TVS is of use in women with postmenopausal bleeding and a probability of endometrial carcinoma below 15%.

LanguageEnglish
Pages275-282
Number of pages8
JournalMaturitas
Volume45
Issue number4
DOIs
Publication statusPublished - 20 Aug 2003

Keywords

  • Cost-effectiveness
  • Postmenopausal bleeding
  • Transvaginal sonography

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Obstetrics and Gynaecology

Cite this

Dijkhuizen, F. P. H. L. J., Mol, B. W. J., Brölmann, H. A. M., & Heintz, A. P. M. (2003). Cost-effectiveness of the use of transvaginal sonography in the evaluation of postmenopausal bleeding. Maturitas, 45(4), 275-282. https://doi.org/10.1016/S0378-5122(03)00152-X
Dijkhuizen, F. Paul H.L.J. ; Mol, Ben W.J. ; Brölmann, Hans A.M. ; Heintz, A. Peter M. / Cost-effectiveness of the use of transvaginal sonography in the evaluation of postmenopausal bleeding. In: Maturitas. 2003 ; Vol. 45, No. 4. pp. 275-282.
@article{2e0f0e56b0584cf39ff2f5b810eab0e9,
title = "Cost-effectiveness of the use of transvaginal sonography in the evaluation of postmenopausal bleeding",
abstract = "Objectives: To assess the cost-effectiveness of transvaginal sonography (TVS) in the diagnostic work-up of women with postmenopausal bleeding. Methods: We performed a decision analysis in which we estimated life expectancy and cost of four strategies for the evaluation of postmenopausal bleeding: TVS (I), TVS and office endometrial biopsy (II), TVS and hysteroscopy (III), and endometrial biopsy (IV). In strategies incorporating TVS, calculations were performed for three different cut-off values between 3 and 9 mm double layer. Expectant management, i.e. no diagnosis or treatment was considered to be the reference strategy to which the other four strategies were compared. Data were obtained from the published literature. In extensive sensitivity analyses, we varied patient's age, discount rate, prevalence of endometrial carcinoma and atypical hyperplasia, and costs. Results: The strategy with endometrial biopsy and the strategy with TVS followed by endometrial biopsy in case of an increased endometrial thickness were the most cost-effective strategies. The strategy starting with endometrial biopsy was the most cost-effective when the prevalence of endometrial carcinoma was ≥15.3{\%}, whereas the strategy with TVS and endometrial biopsy was the most cost-effective for women in which the prevalence of endometrial carcinoma was lower. In these strategies, a cut-off level for abnormality of 9 mm resulted in lowest cost per life-year gained. Conclusions: TVS is of use in women with postmenopausal bleeding and a probability of endometrial carcinoma below 15{\%}.",
keywords = "Cost-effectiveness, Postmenopausal bleeding, Transvaginal sonography",
author = "Dijkhuizen, {F. Paul H.L.J.} and Mol, {Ben W.J.} and Br{\"o}lmann, {Hans A.M.} and Heintz, {A. Peter M.}",
year = "2003",
month = "8",
day = "20",
doi = "10.1016/S0378-5122(03)00152-X",
language = "English",
volume = "45",
pages = "275--282",
journal = "Maturitas",
issn = "0378-5122",
publisher = "Elsevier Ireland Ltd",
number = "4",

}

Cost-effectiveness of the use of transvaginal sonography in the evaluation of postmenopausal bleeding. / Dijkhuizen, F. Paul H.L.J.; Mol, Ben W.J.; Brölmann, Hans A.M.; Heintz, A. Peter M.

In: Maturitas, Vol. 45, No. 4, 20.08.2003, p. 275-282.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cost-effectiveness of the use of transvaginal sonography in the evaluation of postmenopausal bleeding

AU - Dijkhuizen, F. Paul H.L.J.

AU - Mol, Ben W.J.

AU - Brölmann, Hans A.M.

AU - Heintz, A. Peter M.

PY - 2003/8/20

Y1 - 2003/8/20

N2 - Objectives: To assess the cost-effectiveness of transvaginal sonography (TVS) in the diagnostic work-up of women with postmenopausal bleeding. Methods: We performed a decision analysis in which we estimated life expectancy and cost of four strategies for the evaluation of postmenopausal bleeding: TVS (I), TVS and office endometrial biopsy (II), TVS and hysteroscopy (III), and endometrial biopsy (IV). In strategies incorporating TVS, calculations were performed for three different cut-off values between 3 and 9 mm double layer. Expectant management, i.e. no diagnosis or treatment was considered to be the reference strategy to which the other four strategies were compared. Data were obtained from the published literature. In extensive sensitivity analyses, we varied patient's age, discount rate, prevalence of endometrial carcinoma and atypical hyperplasia, and costs. Results: The strategy with endometrial biopsy and the strategy with TVS followed by endometrial biopsy in case of an increased endometrial thickness were the most cost-effective strategies. The strategy starting with endometrial biopsy was the most cost-effective when the prevalence of endometrial carcinoma was ≥15.3%, whereas the strategy with TVS and endometrial biopsy was the most cost-effective for women in which the prevalence of endometrial carcinoma was lower. In these strategies, a cut-off level for abnormality of 9 mm resulted in lowest cost per life-year gained. Conclusions: TVS is of use in women with postmenopausal bleeding and a probability of endometrial carcinoma below 15%.

AB - Objectives: To assess the cost-effectiveness of transvaginal sonography (TVS) in the diagnostic work-up of women with postmenopausal bleeding. Methods: We performed a decision analysis in which we estimated life expectancy and cost of four strategies for the evaluation of postmenopausal bleeding: TVS (I), TVS and office endometrial biopsy (II), TVS and hysteroscopy (III), and endometrial biopsy (IV). In strategies incorporating TVS, calculations were performed for three different cut-off values between 3 and 9 mm double layer. Expectant management, i.e. no diagnosis or treatment was considered to be the reference strategy to which the other four strategies were compared. Data were obtained from the published literature. In extensive sensitivity analyses, we varied patient's age, discount rate, prevalence of endometrial carcinoma and atypical hyperplasia, and costs. Results: The strategy with endometrial biopsy and the strategy with TVS followed by endometrial biopsy in case of an increased endometrial thickness were the most cost-effective strategies. The strategy starting with endometrial biopsy was the most cost-effective when the prevalence of endometrial carcinoma was ≥15.3%, whereas the strategy with TVS and endometrial biopsy was the most cost-effective for women in which the prevalence of endometrial carcinoma was lower. In these strategies, a cut-off level for abnormality of 9 mm resulted in lowest cost per life-year gained. Conclusions: TVS is of use in women with postmenopausal bleeding and a probability of endometrial carcinoma below 15%.

KW - Cost-effectiveness

KW - Postmenopausal bleeding

KW - Transvaginal sonography

UR - http://www.scopus.com/inward/record.url?scp=0042132005&partnerID=8YFLogxK

U2 - 10.1016/S0378-5122(03)00152-X

DO - 10.1016/S0378-5122(03)00152-X

M3 - Article

VL - 45

SP - 275

EP - 282

JO - Maturitas

T2 - Maturitas

JF - Maturitas

SN - 0378-5122

IS - 4

ER -