Page 127 - The diagnostic work-up of women with postmenopausal bleeding

Also more research is needed on the strategy using SIS. In most hospitals in the Netherlands, patients who are diagnosed with an endometrial (pre) cancer present at the outpatient clinic with PMB. During this appointment a TVS is performed and if the endometrium is > 4 mm, an endometrial sample is taken. In the same session it would be possible to perform a SIS. However, the diagnostic accuracy of the tests in case SIS and endometrial sampling are combined is still unknown. One study reported that the proportion of adequate endometrium samples that can be evaluated by the pathologist is higher when endometrial aspiration is done first with subsequent SIS, in a mixed population of pre- and postmenopausal women.31 Thus, the optimal sequence ofTVS and SIS in combination with endometrium sampling in women with postmenopausal women needs to be elucidated.
Conclusion
Our results show that hysteroscopy is not cost-effective in comparison with expectant
management in the prevention of recurrent bleeding.Furthermore,our results show
that with a strategy using hysteroscopy in all women with a thickened endometrium
and benign endometrial sampling, incremental costs per (pre) cancer detected are
around € 11,000 as compared to expectant management. A strategy using SIS to
select women for therapeutic hysteroscopy, is about € 2,000 less expensive per (pre) 6 cancer detected. CEA cur ves showed that the probability for hysteroscopy alone to
be cost-effective in comparison with expectant management is 0.95 at a willingness- to-pay of € 19500 /detected (pre) cancer and for hysteroscopy preceded by a SIS € 16000 /detected (pre) cancer.Thus, decision makers need to decide whether they are willing to pay this amount of money to detect a (pre) cancer. Further research is required to confirm the findings of this study and to elucidate the role of SIS in the diagnostic work-up of women who present with PMB at the outpatient clinic.
Cost-effectiveness
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