Page 119 - The diagnostic work-up of women with postmenopausal bleeding

the ICERs.The bootstrapped cost-effect pairs were plotted on a cost-effectiveness plane (CE plane) and used to estimate cost-effectiveness acceptability curves (CEA curves). On a CE plane, the bootstrapped effect differences are plotted on the x-axis and the bootstrapped cost differences are plotted on the y-axis thereby visually showing the uncertainty surrounding the ICER20. CEA curves show the probability that the intervention is cost-effective in comparison with the control treatment for a range of ceiling ratios.The ceiling ratio is defined as the amount of money society is willing to pay to gain one unit of effect.21
Results
Patients
During the study period, 200 postmenopausal women with uterine bleeding were
included, of whom 98 were randomly allocated to SIS and hysteroscopy and 102
women to expectant management.There were no statistically significant or clinically
relevant differences in patient characteristics between the two groups. Details on
patient characteristics in this study can be found in the original publication.16 The
patient flow of this study is presented in Figure 1. 6
Clinical outcomes
Table 2 shows the results of the analyses of clinical outcomes. After 12 months, recurrent bleeding between the two groups was not statistically significant, with 18 (18%) women in the hysteroscopy group presenting with recurrent bleeding compared to 15 (15.3%) women in the expectant management group.The definite pathology result of six of these 50 women, in whom an endometrial polyp was found, showed a (pre) cancer : three women having FIGO stage I endometroid adenocarcinoma and three women having atypical hyperplasia. During the follow-up period of 12 months one other woman was diagnosed with a FIGO stage I endometrioid adenocarcinoma in the hysteroscopy group as well. Thus, in the hysteroscopy group 6% of women were diagnosed with an endometrial (pre) cancer at initial work-up and another one woman was diagnosed with endometrial cancer during follow-up.This makes a total of 7% (pre) cancers detected during 12 months of follow-up in the hysteroscopy group. Assuming that the prevalence of endometrial cancer was the same in the expectant management group, this constitutes a statistically significant difference in detected carcinoma between the groups (difference 7%, 95% CI 3% to 14%).
Cost-effectiveness
117