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Cost-effectiveness of strategies to evaluate postmenopausal bleeding
S Feldman1, R S Berkowitz, A N Tosteson
1Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham & Women's Hospital, Boston, Massachusetts.
Obstetrics and Gynecology
|June 1, 1993
Summary
For postmenopausal bleeding, office endometrial biopsy is the most cost-effective initial evaluation strategy. Delaying biopsy may be considered for low-risk patients, but office biopsy is preferred over D&C or hysterectomy.
Area of Science:
- Gynecology
- Oncology
- Health Economics
Background:
- Postmenopausal bleeding requires careful evaluation to rule out endometrial cancer and complex hyperplasia.
- Optimal diagnostic strategies vary based on patient age and risk factors.
Purpose of the Study:
- To determine the most effective and cost-effective initial evaluation strategy for postmenopausal bleeding.
- To compare office endometrial biopsy, D&C, hysterectomy, and observation.
Main Methods:
- A decision-analytic model was developed.
- Life expectancy, effectiveness, cost, and cost-effectiveness were assessed.
- Patient age and risk for cancer/complex hyperplasia were considered.
Main Results:
- Office endometrial biopsy emerged as the most cost-effective initial strategy for moderate-risk patients.
- Hysterectomy and D&C were more costly and less effective than office biopsy.
- For low-risk patients, the cost-effectiveness of office biopsy varied by age.
Conclusions:
- Office biopsy is the preferred initial evaluation for postmenopausal bleeding over D&C or hysterectomy.
- Observation until bleeding recurrence may be an option for very low-risk patients.
- Strategy selection should balance cost-effectiveness with patient-specific risk factors.