Clark T J, Barton P M, Coomarasamy A, Gupta J K, Khan K S
Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham, UK.
BJOG. 2006 May;113(5):502-10. doi: 10.1111/j.1471-0528.2006.00914.x.
To determine the most cost-effective outpatient testing strategy for diagnosing endometrial cancer in women with postmenopausal bleeding (PMB).
Decision analysis modelling.
Women with postmenopausal bleeding.
A decision analytic model was constructed to reflect current service provision, which evaluated 12 diagnostic strategies using endometrial biopsy (EB), ultrasonography (USS) (4- and 5-mm endometrial thickness cutoff) and hysteroscopy. Diagnostic probability estimates were derived from systematic quantitative reviews, clinical outcomes from published literature and cost estimates from local and NHS sources.
The cost per additional life year gained (pound/LYG) was determined and compared for each diagnostic strategy, and sensitivity analyses were performed.
Compared with carrying out no initial investigation, a strategy based on initial diagnosis with USS using a 5-mm cutoff was the least expensive (11,470 pound/LYG). Initial investigation with EB or USS using a 4-mm cutoff was comparably cost-effective (less than 30,000 pound/LYG versus USS with a 5-mm cutoff) at their most favourable diagnostic performance and at disease prevalence of 10% or more. The strategies involving initial evaluation with test combinations or hysteroscopy alone were not cost-effective.
Women presenting for the first time with PMB should undergo initial evaluation with USS or EB.
确定绝经后出血（PMB）女性子宫内膜癌诊断的最具成本效益的门诊检测策略。
决策分析建模。
绝经后出血女性。
构建决策分析模型以反映当前服务提供情况，该模型使用子宫内膜活检（EB）、超声检查（USS）（子宫内膜厚度截断值为4毫米和5毫米）和宫腔镜检查评估12种诊断策略。诊断概率估计值来自系统定量综述，临床结果来自已发表文献，成本估计来自当地和英国国家医疗服务体系（NHS）来源。
确定并比较每种诊断策略每获得一个额外生命年的成本（英镑/生命年增益，pound/LYG），并进行敏感性分析。
与不进行初始检查相比，基于超声检查且截断值为5毫米的初始诊断策略成本最低（11,470英镑/生命年增益）。在最有利的诊断性能和疾病患病率为10%或更高时，使用4毫米截断值的子宫内膜活检或超声检查进行初始检查具有相当的成本效益（与截断值为5毫米的超声检查相比，低于30,000英镑/生命年增益）。涉及初始联合检查或仅宫腔镜检查评估的策略不具有成本效益。
首次出现绝经后出血的女性应接受超声检查或子宫内膜活检进行初始评估。
