Presentation (CTI)

OBJECTIVES: Endometrial cancer (EC) is the fourth most common cancer in women in the Western world. It is mostly associated with obesity, and its incidence is on a rise. Until today, there is no proactive screening program focusing on lowering its incidence or morbidity. This research aims to evaluate the cost-effectiveness of an 8.0mm endometrial thickness (ET) Pipelle biopsy as a screening method in asymptomatic postmenopausal women with obesity in Israel, comparing strategies targeted at a body mass index (BMI) > 30 versus a BMI > 35.
METHODS: A decision-tree and Incremental Cost-Effectiveness Ratio (ICER) simulated a cohort of asymptomatic women, aged 55 or more, with obesity (BMI>30) or morbid obesity (BMI>35). Prevalence of EC in this cohort is 45:100,000. Clinical inputs, including diagnostic sensitivity and specificity, were sourced from published retrospective cohort data. Direct additional medical costs for advanced disease, including NGS diagnostics and advanced disease lifetime treatment costs (ILS 545,963 per patient), were included, obtained from the ministry of health tariff.
RESULTS: The model evaluated an estimated 283,903 women with BMI> 30 and 41,940 women with BMI> 35. Using an 8.0mm ET threshold for the BMI> 30 cohort resulted in 14,195 pipelle biopsies to detect 410 EC cases at early stage. Conversely, for the BMI> 35 cohort, the same threshold required only 2,097 biopsies to detect 210 EC cases at early stage. ICER simulation for BMI> 30 = 1,599,642 and ICER simulation for BMI> 35 = -699,953 resulting in a dominant cost effective targeted intervention.
CONCLUSIONS: Targeted EC screening using an 8.00mm ET threshold in asymptomatic postmenopausal women is highly cost-effective when targeted at a BMI>35. By averting advanced disease costs and minimizing unnecessary invasive biopsies, this targeted strategy optimizes resource allocation in Israel and presents a more viable, high-value public health intervention compared to broader screening protocols (BMI > 30).