Cost-effectiveness analysis of annual screening strategies for endometrial cancer

• Published in: American journal of obstetrics and gynecology Vol. 200; no. 6; pp. 640.e1 - 640.e8
• Main Authors: Havrilesky, Laura J., MD, Maxwell, G. Larry, MD, Myers, Evan R., MD, MPH
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.06.2009; Elsevier
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cost-Benefit Analysis; cost-effectiveness; endometrial cancer; Endometrial Neoplasms - diagnosis; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Mass Screening - economics; Mass Screening - methods; Medical sciences; Middle Aged; Obstetrics and Gynecology; serum screening; Tumors; endometrial cancer; cost-effectiveness; serum screening; Endometrium cancer; Health economy; Gynecology; Uterine diseases; Malignant tumor; Cost analysis; Medical screening; Obstetrics; Public health; Cancer; Cost efficiency analysis; Female genital diseases
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2009.02.022

Objective The objective of the study was to determine the cost-effectiveness of annual screening tests for endometrial cancer. Study Design Markov state transition model of the natural history of endometrial cancer used as the design for the study. Incidence was modeled for the general population and high risk groups (obese, body mass index [BMI] of ≥ 30 kg/m2 ; tamoxifen users). Strategies evaluated were no screening, annual endometrial biopsy, annual endovaginal ultrasound, and annual serum screening. Serum screening was based on a recently described biomarker panel (sensitivity of 0.98, specificity of 0.98). Results In the general population model, no screening was least expensive, whereas annual serum screening age at 50-75 years had incremental cost-effectiveness ratio (ICER) of $60,363 per year of life saved (YLS) compared with no screening. In a high-risk population (obesity, BMI of ≥ 30 kg/m2 ), annual serum screening at age 45-80 years had ICER of $41,226 per YLS compared with no screening. Annual endometrial biopsy and annual transvaginal ultrasound were dominated. Conclusion Annual serum screening for endometrial cancer has the potential to be cost effective when applied to high-risk populations.