OBJECTIVES

: To systematically review the current evidence on long-term effectiveness and cost effectiveness of endometrial cancer early detection and prevention strategies in asymptomatic women.

METHODS

: We performed a systematic literature search using relevant electronic databases (Medline/Embase/Cochrane Library/CRD/EconLit) for decision-analytic modelling studies assessing the cost effectiveness of early detection and/or prevention strategies for endometrial cancer. Study characteristics and results were summarized in standardized evidence tables. Outcomes included quality-adjusted life-years (QALY), life-years gained (LYG), and incremental cost-effectiveness ratios (ICER). Economic results were converted to 2017 Euros using GDP (PPP) and CPI.

RESULTS

: Seven studies evaluating early detection and prevention strategies for endometrial cancer in asymptomatic women with different cancer risk profiles were included. The strategies are: (1) Family history based genetic testing for germline mutations and prevention strategies for diagnosed mutation carriers, (2) endometrial cancer screening in women with different risk profiles, (3) preventive measures including prophylactic surgery in women at high risk for endometrial cancer. Genetic testing for Lynch syndrome in women 25-40 years old with a family history of endometrial cancer, followed by prevention strategies yielded ICERs below 40,000 Euro/QALY. Transvaginal ultrasound (TVS) and biopsy were shown to be cost effective in women with Lynch Syndrome with an ICER of 37,000 Euro/LYG. Prevention using contraceptives in obese women revealed ICERs above 82,000 Euro/LYG. Prophylactic surgery in asymptomatic women with Lynch syndrome at age 40 years achieved ICERs below 11,000 Euro/QALY.

CONCLUSIONS

: The results of our study suggest that in asymptomatic women at high risk for endometrial cancer, genetic testing for mutation and preventive strategies for mutation carriers can be considered cost effective. Except for women with diagnosed Lynch syndrome screening strategies using TVS or endometrial biopsy cannot be considered cost effective. However, included studies did not consider different endometrial thickness.