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Updated: Apr 16, 2026
Author Spotlight: A Reproductive Hysteroscopy Approach for Complete Endometrial Polyp Removal and Enhanced Endometrial Receptivity
Published on: August 2, 2024
Does probability guided hysteroscopy reduce costs in women investigated for postmenopausal bleeding?
M C Breijer1, N van Hanegem2, N C M Visser3
1Department 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.
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.
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