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. 2022 Jan;164(1):93-97.
doi: 10.1016/j.ygyno.2021.10.079. Epub 2021 Oct 28.

The cost of diagnosing endometrial cancer: Quantifying the healthcare cost of an abnormal uterine bleeding workup

Simrit K Warring  1 , Bijan Borah  2 , James Moriarty  2 , Rachel Gullerud  2 , Maureen A Lemens  1 , Christopher Destephano  3 , Mark E Sherman  4 , Jamie N Bakkum-Gamez  5
Affiliations

The cost of diagnosing endometrial cancer: Quantifying the healthcare cost of an abnormal uterine bleeding workup

Simrit K Warring et al. Gynecol Oncol. 2022 Jan.

Abstract

Objective: The evaluation of women with perimenopausal abnormal uterine bleeding (AUB) and postmenopausal bleeding (PMB) to detect endometrial cancer (EC) and its precursors is not standardized and can vary widely. Consequently, costs associated with the workup and management undoubtedly vary. This study aimed to quantify costs of AUB/PMB evaluation to understand the healthcare burden associated with securing a pathologic diagnosis.

Methods: Women ≥45 years of age presenting to a single institution gynecology clinic with AUB/PMB for diagnostic workup were prospectively enrolled February 2013-October 2017 for a lower genital tract biospecimen research study. Clinical workup of AUB/PMB was determined by individual provider discretion. Costs of care were collected from administrative billing systems from enrollment to 90 days post enrollment. Costs were standardized and inflation-adjusted to 2017 US Dollars (USD).

Results: In total, there were 1017 women enrolled with 5.6% diagnosed with atypical hyperplasia or endometrial cancer (EC). Within the full cohort, 90-day median cost for AUB/PMB workup and management was $2279 (IQR $512-4828). Among patients with a diagnostic biopsy, median 90-day costs ranged from $2203 (IQR $499-3604) for benign or disordered proliferative endometrium (DPE) diagnosis to $21,039 (IQR $19,084-24,536) for a diagnosis of EC.

Conclusions: The costs for diagnostic evaluation of perimenopausal AUB and PMB vary greatly according to ultimate tissue-based diagnosis. Even reassuring benign findings that do not require further intervention-the most common in this study's cohort-yield substantial costs. The development of sensitive, specific, and more cost-effective diagnostic strategies is warranted.

Keywords: Cost; Endometrial cancer; Perimenopausal abnormal uterine bleeding; Postmenopausal bleeding.

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Conflict of interest statement

Declaration of Competing Interest Dr. Jamie Bakkum-Gamez was funded as noted above by The V Foundation for Cancer Research (T2016–001-03) and National Cancer Institute (grants P30 CA 15083 and Z01CP010124–21). She is also listed as an inventor on intellectual property owned by Mayo Clinic and licensed to Exact Sciences. Bijan Borah is a consultant for Exact Sciences. Dr. Mark Sherman participates in research on developing an early endometrial cancer detection test, which is partly funded by Exact Sciences.

References

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