OBJECTIVES : This goal of this study was to use insurance claims in a real-world setting to describe common diagnostic and treatment patterns and associated cost burden for women who received an endometrial biopsy after being diagnosed with postmenopausal bleeding.

METHODS : The IBM MarketScan Commercial and Medicare Supplemental Databases were used to identify women with continuous enrolment for at least 2 years following a diagnosis of postmenopausal bleeding (ICD-9 code 627.1, ICD-10 code N950) during 2012-2017. Outcomes of interest were receipt of endometrial biopsy, repeat endometrial biopsy, and transvaginal ultrasound and diagnosis of endometrial hyperplasia and/or endometrial cancer. Healthcare resource utilization and costs were estimated for various diagnostic and treatment pathways.

RESULTS : 61,186 women (mean age 57) with postmenopausal bleeding were identified in the database. Of these, 27,032 (44%) had evidence of an endometrial biopsy and 11,464 (19%) had 2-years continuous enrolment following the biopsy. 6% of women were diagnosed with endometrial hyperplasia and 3% were diagnosed with endometrial cancer within 90 days of their initial biopsy. Approximately 10% of women received an additional endometrial biopsy within 2 years of their initial biopsy (median time to the second biopsy was 312 days). Among women receiving two biopsies, 19% were diagnosed with endometrial hyperplasia and 2% were diagnosed with endometrial cancer within 90 days of their second biopsy. On average, women had 6.9 physician visits and incurred $12,912 in total healthcare costs ($2527 in pharmacy costs) in the period between their two biopsies. 62% of women received a transvaginal ultrasound during the period between their two biopsies.

CONCLUSIONS : Approximately 10% of women receive multiple endometrial biopsies following a diagnosis of postmenopausal bleeding with significant healthcare utilization between biopsies. Approximately 2% of women with two biopsies are diagnosed with endometrial cancer within 90 days of their second biopsy.