Page 118 - The diagnostic work-up of women with postmenopausal bleeding

Chapter 6
It was assumed that effects in this strategy would be the same as in the hysteroscopy only strategy, as SIS was shown to have high diagnostic accuracy (sensitivity 93% and specificity 94%).16 In this scenario, an inconclusive SIS was followed by a hysteroscopy. The different strategies are shown in Figure 1 and 2.
Figure 2. Hypothetic strategy using SIS to select women for hysteroscopy
200 women with PMB
Expectant management n=98
Diagnostic work up n=98
No SIS n=19
SIS n=79
No polyp n=33
Pos / inconclusive n=46
Expectant management n=33
hysteroscopy n=46 polyp n=43
no polyp n=3
Expectant management
Cost-effectiveness analysis
The cost-effectiveness analyses were performed according to the intention-to-treat principle.Imputation was not necessary,because complete data were available for all participants.Incremental cost-effectiveness ratios (ICERs) were calculated by dividing the difference in costs between the two intervention groups by the difference in effects, resulting in an estimate of the additional costs associated with one case of recurrent blood loss prevented and with one carcinoma extra detected.
Differences in costs and effects between the two intervention groups were estimated using bivariate regression models to account for the possible correlation between costs and effects. Because of the skewed distribution of costs, bias- corrected and accelerated bootstrapping was used to estimate 95% confidence intervals around cost differences and to estimate statistical uncertainty surrounding
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