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Cost-Effectiveness analysis of biopsy strategies for endometrial cancer diagnosis in women with postmenopausal bleeding: Pipelle sampling curette versus dilatation & curettage

Yi, Yan (2017) Cost-Effectiveness analysis of biopsy strategies for endometrial cancer diagnosis in women with postmenopausal bleeding: Pipelle sampling curette versus dilatation & curettage. Master Essay, University of Pittsburgh.

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Abstract

Background:
Endometrial cancer (EC) is the most common gynecologic cancer affecting US women and usually requires a histological evaluation of an endometrial sample to be accurately diagnosed. The in-office usage of Pipelle endometrial biopsy has similar diagnostic accuracy for EC diagnosis and is cheaper than the traditional method-Dilatation & Curettage (D&C). However, the main drawback to Pipelle biopsy is its relatively higher sampling failure rate. The objective of this study was to explore the cost-effectiveness of two endometrial sampling procedures for diagnosing EC: 1) Pipelle endometrial biopsy and 2) D&C, accounting for both sampling procedure failure rates and diagnostic accuracy in women with postmenopausal bleeding (PMB).
Method:
The decision analytic model was built to compare the cost effectiveness of Pipelle biopsy and D&C strategy in a hypothetical cohort of PMB women. The analysis was performed from the perspective of a public healthcare payer (Medicare, US). We used 2017 Medicare reimbursement data to estimate costs for procedures in the model. The effectiveness of these two diagnostic strategies was measured by analyzing the remaining life expectancy. We compared the performance of the two procedures using the incremental cost and incremental effectiveness, and conducted one-way sensitivity analyses and Monte Carlo probabilistic sensitivity analysis to assess the effect of uncertainty on the result.
Results:
The base case analysis suggested that the Pipelle biopsy strategy was not only equally effective (32.11 vs. 32.11 years of life) but also less costly ($1897.80 vs. $2999.11) in comparison to D&C strategy. In one-way sensitivity analyses and Monte Carlo probabilistic sensitivity analysis, the Pipelle biopsy remained the more cost-effective strategy after accounting for uncertainties of variables.
Conclusion:
The Pipelle biopsy is the more cost-effective sampling strategy for EC diagnosis in women with PMB when compared to D&C. From a cost-effective perspective, the relatively higher sampling failure rate of Pipelle should not be regarded as a limitation in its clinical application. These findings have important public health significance as they have potentials to improve diagnostic efficiency of endometrial pathologies which affect millions of women in the US, and they can be broadly generalizable in Medicare providers in the US.


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Details

Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Yi, Yanyay65@pitt.eduyay65@pitt.edu
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairBodnar, Lisabodnar@edc.pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberLinkov, Fainalinkfy@mail.magee.eduUNSPECIFIEDUNSPECIFIED
Committee MemberBryce, Cindybryce99@pitt.eduUNSPECIFIEDUNSPECIFIED
Centers: Other Centers, Institutes, Offices, or Units > Magee-Women's Research Institute
Date: 26 November 2017
Date Type: Submission
Number of Pages: 39
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 17 Jul 2018 17:37
Last Modified: 01 Jan 2021 06:15
URI: http://d-scholarship.pitt.edu/id/eprint/33427

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