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Cost-Utility of Routine Endometrial Evaluation Before Le Fort Colpocleisis

Kandadai, Padma MD; Flynn, Michael MD, MHS; Zweizig, Susan MD; Patterson, Danielle MD, MSc

Female Pelvic Medicine & Reconstructive Surgery: May/June 2014 - Volume 20 - Issue 3 - p 168–173
doi: 10.1097/SPV.0000000000000043
Original Article
Journal Club
Journal Club Q and A

Introduction: Routine preoperative evaluation of the endometrium before Le Fort colpocleisis is often recommended. There are no data, however, to support this practice. In select patients, it may not be a necessary addition to the preoperative evaluation of Le Fort colpocleisis.

Methods: A decision analysis model was created to compare uterine evaluation, by either endometrial (EM) biopsy or transvaginal ultrasound, to no evaluation for a hypothetical cohort of women undergoing Le Fort colpocleisis. We assumed the absence of risk factors for EM cancer. Probabilities and health outcome utilities were obtained from literature review. Medicare charges were used to estimate cost in 2012 US dollars. Cost-utility analysis was performed using US recommendations from a health plan perspective.

Results: At willingness-to-pay thresholds of $50,000 and $100,000, no evaluation is superior to both biopsy and ultrasound. At a 64% probability of cancer, biopsy is more cost-effective than no evaluation and ultrasound.

Conclusions: Compared to biopsy and ultrasound, in low-risk women, no EM evaluation before Le Fort colpocleisis demonstrates superior cost-utility.

In low-risk women undergoing Le Fort colpocleisis, endometrial evaluation by either biopsy or ultrasound seems to be less cost-effective than not evaluating the cavity.

From the Divisions of *Urogynecology and Reconstructive Pelvic Surgery, and †Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Massachusetts Memorial Medical Center, Worcester, MA.

Reprints: Padma Kandadai, MD, Department of Obstetrics and Gynecology, University of Massachusetts Medical Center, 119 Belmont St, Jaquith 2nd Floor, Worcester, MA 01605. E-mail: pkandadai@gmail.com.

The authors have declared they have no conflicts of interest.

Presented at the 33rd Annual Scientific Meeting, American Urogynecologic Society, Chicago, IL, October 4, 2012.

P. Kandadai was responsible for the project development, data management, data analysis, and manuscript writing/editing; M. Flynn and S. Zweizig, project development and manuscript editing; and D. Patterson, project development, data analysis, and manuscript editing.

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