Weber A M, Belinson J L, Bradley L D, Piedmonte M R
Department of Gynecology and Obstetrics, Cleveland Clinic Foundation, OH 44195, USA.
Am J Obstet Gynecol. 1997 Oct;177(4):924-9. doi: 10.1016/s0002-9378(97)70295-3.
Our goal was to compare the predicted outcomes and costs of two diagnostic algorithms for postmenopausal bleeding.
Two algorithms for postmenopausal bleeding were developed, one with vaginal ultrasonography and the other with office endometrial biopsy as the first test. Literature review was performed to estimate the probability of either an abnormal result of ultrasonography or a nondiagnostic biopsy, or both. Cost and sensitivity analyses were performed.
Estimated probability of a nondiagnostic endometrial biopsy was 28%, and estimated probability of an abnormal result of vaginal ultrasonography (either inconclusive or endometrial thickness > 4 mm) was 55%. Cost analysis showed that vaginal ultrasonography as the first diagnostic test cost $230 per patient on average compared with $244 for endometrial biopsy, with savings ranging from $14 to $20 per patient over a wide range of possible values for estimated parameters.
Vaginal ultrasonography costs slightly less than office endometrial biopsy as the first test in the diagnostic evaluation of women with postmenopausal bleeding.
我们的目标是比较两种绝经后出血诊断算法的预测结果和成本。
开发了两种绝经后出血诊断算法，一种以阴道超声检查作为首选检查，另一种以门诊子宫内膜活检作为首选检查。通过文献回顾来估计超声检查结果异常或活检结果无法诊断，或两者皆有的概率。进行了成本和敏感性分析。
估计子宫内膜活检结果无法诊断的概率为28%，估计阴道超声检查结果异常（不确定或子宫内膜厚度>4mm）的概率为55%。成本分析表明，将阴道超声检查作为首选诊断检查时，平均每位患者花费230美元，而子宫内膜活检为244美元，在估计参数的广泛可能值范围内，每位患者可节省14至20美元。
在绝经后出血女性的诊断评估中，将阴道超声检查作为首选检查，其成本略低于门诊子宫内膜活检。
