Cost-effectiveness of diagnostic strategies for the management of abnormal uterine bleeding (heavy menstrual bleeding and post-menopausal bleeding): a decision analysis

Cooper, Natalie Am; Barton, Pelham; Breijer, Maria; Caffrey, Orla; Opmeer, Brent C.; Timmermans, Anne; Mol, Ben W J; Khan, Khalid S.; Clark, T. Justin

doi:10.3310/hta18240

Cited by 37 publications

(50 citation statements)

References 102 publications

(257 reference statements)

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“…Other factors, such as lower cost, less discomfort and wide availability, make SCSH a potential first-line diagnostic tool in the work-up of women with AUB 23 . To provide an overview on cost comparison between SCSH and hysteroscopy, cost-effectiveness of diagnostic strategies for the management of AUB provided by the National Institute for Health Research estimated that cost of hysteroscopy was £3182, whereas the overall cost of SCSH was assumed to be £1083 24 .…”

Section: Discussionmentioning

confidence: 99%

Accuracy of saline contrast sonohysterography in detection of endometrial polyps and submucosal leiomyomas in women of reproductive age with abnormal uterine bleeding: systematic review and meta‐analysis

Bittencourt

Simões

Bernardo

et al. 2017

Ultrasound in Obstet & Gyne

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Section: Discussionmentioning

confidence: 99%

Accuracy of saline contrast sonohysterography in detection of endometrial polyps and submucosal leiomyomas in women of reproductive age with abnormal uterine bleeding: systematic review and meta‐analysis

Bittencourt

Simões

Bernardo

et al. 2017

Ultrasound in Obstet & Gyne

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“…Accurate diagnosis is of ultimate importance to achieve effective treatment, reducing morbidity and reducing mortality. There are many tests available, including transvaginal scan (TVS), endometrial biopsy, and saline infusion sonography and outpatient hysteroscopy; however, optimal diagnostic work-up is unclear [6].…”

Section: Discussionmentioning

confidence: 99%

“…However, Hysteroscopy is expensive and requires specific equipment and in some patients, anesthesia is required [6] [7].…”

Section: Introductionmentioning

confidence: 99%

A Comparative Observational Study of the Use Transvaginal Ultrasound and Hysteroscopy for the Detection of Uterine Cavity Pathologies in Women with Abnormal Uterine Bleeding

Elsersy¹

2017

OJOG

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Background: 70% of all gynecological consultations are for abnormal uterine bleeding. Any approach to optimal management begins with an appropriate diagnosis. 40% of premenopausal women with abnormal uterine bleeding were found to have some intrauterine pathology. This study aims to compare the diagnostic value of transvaginal ultrasonography in comparison to hysteroscopy in detecting uterine abnormalities in patients with abnormal uterine bleeding. Methods: Retrospective observational cross sectional study of 250 women presented with abnormal uterine bleeding. The patients who fulfilled the selection criteria and have been sequentially investigated by transvaginal ultrasound (TVS) and hysteroscopy were included. Results: 90% of patients were from 35 -49 yrs. 81.2% of patients have body mass index above 25 kg/m 2 .Transvaginal ultrasound (TVS) compared well with high sensitivity as regards normal endometrium. (TVS) missed 4 patients of endometrial polyps and one patient of sub mucous fibroid. Three patients of adenomyosis were only diagnosed by (TVS); they were reported as being normal by hysteroscopy. Conclusion: (TVS) is considered as an excellent approach to the initial evaluation of uterine pathologies in patients with abnormal uterine bleeding.

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“…However, this approach requires general anaesthesia, is associated with morbidity arising from uterine trauma, and has been shown to have limited diagnostic accuracy, because detecting and removing focal pathologies is notoriously problematic without direct visualisation. [12][13][14][15] The advent of convenient imaging of the uterine cavity using ultrasound or endoscopic technologies has largely replaced the D&C for endometrial evaluation; 16 when histological tissue samples are indicated, they can be obtained at the same time utilising blind, miniature outpatient biopsy devices 17,18 or, in the case of hysteroscopy, guided biopsy. 19,20 Transvaginal ultrasound scan (TVS) is the least invasive outpatient test to evaluate the endometrium, as it avoids potentially painful instrumentation of the uterine cavity; the ultrasound probe simply sits within the top of the vagina.…”

Section: Diagnosis Of Uterine Polypsmentioning

confidence: 99%

“…22,[27][28][29] Although SIS is popular in some parts of Europe and North America, OPH is more widely practised in the UK and worldwide. This is because the skills of hysteroscopy are more widely attained by practising gynaecologists and it is safely practised 30,31 but also because OPH allows convenient simultaneous removal of polyp ('see and treat'), 32 may be more cost-effective 16 and appears to be preferred by women. 33,34 In contrast with OPH, SIS has the advantage of allowing assessment and visualisation of other pelvic structures, and visualisation of potential myometrial and adnexal abnormalities.…”

Section: Diagnosis Of Uterine Polypsmentioning

confidence: 99%

A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding

Clark

Middleton

Cooper

et al. 2015

Health Technol Assess

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BackgroundUterine polyps cause abnormal bleeding in women and conventional practice is to remove them in hospital under general anaesthetic. Advances in technology make it possible to perform polypectomy in an outpatient setting, yet evidence of effectiveness is limited.ObjectivesTo test the hypothesis that in women with abnormal uterine bleeding (AUB) associated with benign uterine polyp(s), outpatient polyp treatment achieved as good, or no more than 25% worse, alleviation of bleeding symptoms at 6 months compared with standard inpatient treatment. The hypothesis that response to uterine polyp treatment differed according to the pattern of AUB, menopausal status and longer-term follow-up was tested. The cost-effectiveness and acceptability of outpatient polypectomy was examined.DesignA multicentre, non-inferiority, randomised controlled trial, incorporating a cost-effectiveness analysis and supplemented by a parallel patient preference study. Patient acceptability was evaluated by interview in a qualitative study.SettingOutpatient hysteroscopy clinics and inpatient gynaecology departments within UK NHS hospitals.ParticipantsWomen with AUB – defined as heavy menstrual bleeding (formerly known as menorrhagia) (HMB), intermenstrual bleeding or postmenopausal bleeding – and hysteroscopically diagnosed uterine polyps.InterventionsWe randomly assigned 507 women, using a minimisation algorithm, to outpatient polypectomy compared with conventional inpatient polypectomy as a day case in hospital under general anaesthesia.Main outcome measuresThe primary outcome was successful treatment at 6 months, determined by the woman’s assessment of her bleeding. Secondary outcomes included quality of life, procedure feasibility, acceptability and cost per quality-adjusted life-year (QALY) gained.ResultsAt 6 months, 73% (166/228) of women who underwent outpatient polypectomy were successfully treated compared with 80% (168/211) following inpatient polypectomy [relative risk (RR) 0.91, 95% confidence interval (CI) 0.82 to 1.02]. The lower end of the CIs showed that outpatient polypectomy was at most 18% worse, in relative terms, than inpatient treatment, within the 25% margin of non-inferiority set at the outset of the study. By 1 and 2 years the corresponding proportions were similar producing RRs close to unity. There was no evidence that the treatment effect differed according to any of the predefined subgroups when treatments by variable interaction parameters were examined. Failure to completely remove polyps was higher (19% vs. 7%; RR 2.5, 95% CI 1.5 to 4.1) with outpatient polypectomy. Procedure acceptability was reduced with outpatient compared with inpatient polyp treatment (83% vs. 92%; RR 0.90, 95% CI 0.84 to 0.97). There were no significant differences in quality of life. The incremental cost-effectiveness ratios at 6 and 12 months for inpatient treatment were £1,099,167 and £668,800 per additional QALY, respectively.ConclusionsWhen treating women with AUB associated with uterine polyps, outpatient polypectomy was non-inferior to inpatient polypectomy at 6 and 12 months, and relatively cost-effective. However, patients need to be aware that failure to remove a polyp is more likely with outpatient polypectomy and procedure acceptability lower.Trial registrationCurrent Controlled Trials ISRCTN 65868569.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 61. See the NIHR Journals Library website for further project information.

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Cost-effectiveness of diagnostic strategies for the management of abnormal uterine bleeding (heavy menstrual bleeding and post-menopausal bleeding): a decision analysis

Cited by 37 publications

References 102 publications

Accuracy of saline contrast sonohysterography in detection of endometrial polyps and submucosal leiomyomas in women of reproductive age with abnormal uterine bleeding: systematic review and meta‐analysis

Accuracy of saline contrast sonohysterography in detection of endometrial polyps and submucosal leiomyomas in women of reproductive age with abnormal uterine bleeding: systematic review and meta‐analysis

A Comparative Observational Study of the Use Transvaginal Ultrasound and Hysteroscopy for the Detection of Uterine Cavity Pathologies in Women with Abnormal Uterine Bleeding

A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding

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