Research Article Does Probability Guided Hysteroscopy Reduce Costs in Women Investigated for Postmenopausal Bleeding? M. C. Breijer, 1,2 N. van Hanegem, 1,3 N. C. M. Visser, 4 R. H. M. Verheijen, 5 B. W. J. Mol, 6 J. M. A. Pijnenborg, 7 B. C. Opmeer, 8 and A. Timmermans 1 1 Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands 2 Department of Obstetrics and Gynecology, Erasmus Medical Center, ’s Gravendijkwal 230, 3015 CE Rotterdam, Netherlands 3 Department of Obstetrics and Gynecology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, Netherlands 4 Department of Pathology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, Netherlands 5 Division of Women and Baby, Gynecological Oncology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, Netherlands 6 he Robinson Institute, School of Paediatrics and Reproductive Health, he University of Adelaide, Level 3, Medical School South, Frome Road, Adelaide, SA 5005, Australia 7 Department of Obstetrics and Gynecology, TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD Tilburg, Netherlands 8 Clinical Research Unit, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands Correspondence should be addressed to M. C. Breijer; mbreijer@gmail.com Received 28 July 2014; Accepted 11 December 2014 Academic Editor: Eun-Kyoung Breuer Copyright © 2015 M. C. Breijer et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To evaluate whether a model to predict a failed endometrial biopsy in women with postmenopausal bleeding (PMB) and a thickened endometrium can reduce costs without compromising diagnostic accuracy. Design, Setting, and Population. Model based cost-minimization analysis. Methods. A decision analytic model was designed to compare two diagnostic strategies for women with PMB: (I) attempting oice endometrial biopsy and performing outpatient hysteroscopy ater failed biopsy and (II) predicted probability of a failed endometrial biopsy based on patient characteristics to guide the decision for endometrial biopsy or immediate hysteroscopy. Robustness of assumptions regarding costs was evaluated in sensitivity analyses. Main Outcome Measures. Costs for the diferent strategies. Results. At diferent cut-ofs for the predicted probability of failure of an endometrial biopsy, strategy I was generally less expensive than strategy II. he costs for strategy I were always C 460; the costs for strategy II varied between C 457 and C 475. At a 65% cut-of, a possible saving ofC 3 per woman could be achieved. Conclusions. Individualizing the decision to perform an endometrial biopsy or immediate hysteroscopy in women presenting with postmenopausal bleeding based on patient characteristics does not increase the eiciency of the diagnostic work-up. 1. Introduction Postmenopausal bleeding (PMB) is the most common pre- senting symptom of endometrial cancer and warrants further investigation [1]. Since the 1990s, endometrial thickness measured by transvaginal ultrasound was introduced to select women for further invasive diagnostic testing to detect or rule out endometrial cancer [2–4]. Although the optimal endometrial thickness cut-of for women with PMB still remains questionable, at present most guidelines advise an endometrial thickness cut-of of 4 or 5 mm to select patients for further histological veriication [1, 5–10]. Outpatient endometrial biopsy is the least invasive technique to obtain material for histological assessment. Pipelle endometrial biopsy (Pipelle de Cornier, Paris, France) is the most accurate endometrial sampling device to detect endometrial carci- noma and endometrial hyperplasia in patients with PMB [11]. Furthermore, a strategy with endometrial biopsy ater endometrial thickness measurement is the most cost-efective diagnostic strategy for patients with PMB [12]. Hindawi Publishing Corporation e Scientific World Journal Volume 2015, Article ID 605312, 5 pages http://dx.doi.org/10.1155/2015/605312