Abstract

Objectives

Abnormal uterine bleeding most often has benign cause, but symptomatic cancers need to be found and treated quickly. An objective DNA methylation test, the Women’s Cancer Risk Identification—quantitative polymerase chain reaction test for Endometrial Cancer (WID-qEC), has equivalent sensitivity to transvaginal ultrasound (TVUS) for endometrial cancer detection but better specificity and lower failure rates. We conducted a cost-minimization analysis of WID-qEC versus TVUS for initial evaluation of abnormal uterine bleeding in those aged 45 years or older in secondary care cancer exclusion services.

Methods

The EPI-SURE study was a single-center prospective evaluation of the comparative diagnostic accuracy of WID-qEC and TVUS. A decision-analytic model was constructed using individual-level EPI-SURE data and National Health Service reference costs. Data from participants in EPI-SURE were combined with assumptions about downstream testing and estimates of relevant costs to determine the costs associated with initial evaluation by WID-qEC or TVUS.

Results

Definitive evaluation was required for 57% of patients with initial evaluation by TVUS but only for 12% of patients with initial evaluation by WID-qEC. A breakeven price of £302 was estimated, with a very high probability (>99%) of WID-qEC resulting in cost savings at an indicative price of £200. A sensitivity analysis using a higher threshold for WID-qEC generated greater savings (breakeven price £331). At a WID-qEC price of £150, the mean cost saving was £152 per patient.

Conclusions

Use of the WID-qEC as the first line triage test in patients aged 45 years or older undergoing urgent evaluation of abnormal uterine bleeding has the potential to reduce costs and unnecessary invasive, often painful, subsequent testing.