Does probability guided hysteroscopy reduce costs in women investigated for postmenopausal bleeding?

M C Breijer*, N van Hanegem, N C M Visser, R H M Verheijen, B W J Mol, J M A Pijnenborg, B C Opmeer, A Timmermans

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


OBJECTIVE: To evaluate whether a model to predict a failed endometrial biopsy in women with postmenopausal bleeding (PMB) and a thickened endometrium can reduce costs without compromising diagnostic accuracy.

DESIGN, SETTING, AND POPULATION: Model based cost-minimization analysis.

METHODS: A decision analytic model was designed to compare two diagnostic strategies for women with PMB: (I) attempting office endometrial biopsy and performing outpatient hysteroscopy after failed biopsy and (II) predicted probability of a failed endometrial biopsy based on patient characteristics to guide the decision for endometrial biopsy or immediate hysteroscopy. Robustness of assumptions regarding costs was evaluated in sensitivity analyses.

MAIN OUTCOME MEASURES: Costs for the different strategies.

RESULTS: At different cut-offs for the predicted probability of failure of an endometrial biopsy, strategy I was generally less expensive than strategy II. The costs for strategy I were always € 460; the costs for strategy II varied between € 457 and € 475. At a 65% cut-off, a possible saving of € 3 per woman could be achieved.

CONCLUSIONS: Individualizing the decision to perform an endometrial biopsy or immediate hysteroscopy in women presenting with postmenopausal bleeding based on patient characteristics does not increase the efficiency of the diagnostic work-up.

Original languageEnglish
Article number605312
JournalThe Scientific World Journal
Publication statusPublished - 2015


  • Aged
  • Biopsy
  • Costs and Cost Analysis
  • Decision Support Techniques
  • Diagnostic Errors
  • Endometrial Neoplasms
  • Endometrium
  • Female
  • Humans
  • Hysteroscopy
  • Middle Aged
  • Postmenopause
  • Probability
  • Uterine Hemorrhage

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