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• W2971305456 abstract "Background Despite demonstrated evidence that ultrasound is accurate in the detection of ovarian endometriomas and deep endometriosis, realization of ultrasound's full potential remains variable, resulting in generally poor adoption of the tool in clinical practice. The traditional pathway of a planned two-step approach (diagnostic laparoscopy possibly followed by operative laparoscopy, based on initial results) remains a reality. Besides the clinical implications to patients who suffer greatly from their symptoms, the economic impact on the healthcare system is significant. Methods We aim to compare the economic costs of two models of care in the workup and management of patients with potential endometriosis, both of which hypothetically take place in a tertiary care clinic with high disease prevalence in New South Wales, Australia. The conventional model (M1) includes patients having a basic pelvic ultrasound, which exclusively assesses the uterus and ovaries, whereas the novel model (M2) includes patients undergoing a deep endometriosis ultrasound, which evaluates the uterus, ovaries, anterior and posterior compartment (bladder, ureters, bowel, uterosacral ligaments, torus uterinus, rectovaginal septum, vagina, pouch of Douglas (POD)), soft markers (ovarian mobility, site-specific tenderness), and POD obliteration state using the sliding sign technique. A state-based Markov model with a 12-month time horizon was built to estimate the change to government, health service and patient costs with the adoption of the novel deep endometriosis ultrasound. Cost data were sourced from the Australian government's Medicare Benefits Schedule and the Independent Hospital Pricing Authority. Transition probabilities were sourced from the best available evidence from the literature and clinical consensus. The models utilized a population of 1000 patients visiting a public gynaecology clinic for signs and symptoms of endometriosis. Estimates for endometriosis prevalence and severity were drawn from local data, which was based on laparoscopic and/or histological findings and has been previously published: normal pelvis, 16%; isolated superficial endometriosis, 35%; endometriomas, 16%; deep endometriosis and/or pouch of Douglas obliteration, 33%. Results The total annual costs of the two models are (M1) $13,472,161.67AUD and (M2) $12,547,724.03AUD. Conclusions For a population of 1000 women with signs and symptoms of endometriosis visiting a tertiary care clinic, the integration of the novel deep endometriosis ultrasound may save healthcare costs of $924,437AUD annually. The combined healthcare savings and the clinical value of reducing the incidence of invasive diagnostic laparoscopy by integrating deep endometriosis ultrasound should encourage governing bodies and others responsible for healthcare expenditures to improve practices." @default.
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• W2971305456 date "2019-01-01" @default.
• W2971305456 modified "2023-09-27" @default.
• W2971305456 title "Cost analysis of the use of deep endometriosis transvaginal ultrasound in the workup of patients with symptoms of endometriosis" @default.
• W2971305456 doi "https://doi.org/10.1016/j.ultrasmedbio.2019.07.350" @default.
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