{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T11:12:40Z","timestamp":1776337960830,"version":"3.51.2"},"reference-count":44,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2020,7,11]],"date-time":"2020-07-11T00:00:00Z","timestamp":1594425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010661","name":"Horizon 2020","doi-asserted-by":"publisher","award":["634570"],"award-info":[{"award-number":["634570"]}],"id":[{"id":"10.13039\/100010661","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Endometrial cancer is the most common female genital tract cancer in developed countries. We systematically reviewed the current health-economic evidence on early detection and prevention strategies for endometrial cancer based on a search in relevant databases (Medline\/Embase\/Cochrane Library\/CRD\/EconLit). Study characteristics and results including life-years gained (LYG), quality-adjusted life-years (QALY) gained, and incremental cost-effectiveness ratios (ICERs) were summarized in standardized evidence tables. Economic results were transformed into 2019 euros using standard conversion methods (GDP-PPP, CPI). Seven studies were included, evaluating (1) screening for endometrial cancer in women with different risk profiles, (2) risk-reducing interventions for women at increased or high risk for endometrial cancer, and (3) genetic testing for germline mutations followed by risk-reducing interventions for diagnosed mutation carriers. Compared to no screening, screening with transvaginal sonography (TVS), biomarker CA-125, and endometrial biopsy yielded an ICER of 43,600 EUR\/LYG (95,800 EUR\/QALY) in women with Lynch syndrome at high endometrial cancer risk. For women considering prophylactic surgery, surgery was more effective and less costly than screening. In obese women, prevention using Levonorgestrel as of age 30 for five years had an ICER of 72,000 EUR\/LYG; the ICER for using oral contraceptives for five years as of age 50 was 450,000 EUR\/LYG. Genetic testing for mutations in women at increased risk for carrying a mutation followed by risk-reducing surgery yielded ICERs below 40,000 EUR\/QALY. Based on study results, preventive surgery in mutation carriers and genetic testing in women at increased risk for mutations are cost-effective. Except for high-risk women, screening using TVS and endometrial biopsy is not cost-effective and may lead to overtreatment. Model-based analyses indicate that future biomarker screening in women at increased risk for cancer may be cost-effective, dependent on high test accuracy and moderate test costs. Future research should reveal risk-adapted early detection and prevention strategies for endometrial cancer.<\/jats:p>","DOI":"10.3390\/cancers12071874","type":"journal-article","created":{"date-parts":[[2020,7,14]],"date-time":"2020-07-14T11:03:23Z","timestamp":1594724603000},"page":"1874","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Cost-Effectiveness of Early Detection and Prevention Strategies for Endometrial Cancer\u2014A Systematic Review"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5193-0492","authenticated-orcid":false,"given":"Gaby","family":"Sroczynski","sequence":"first","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT\u2014University for Health Sciences, Medical Informatics and Technology, A-6060 Hall i.T., Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Artemisa","family":"Gogollari","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT\u2014University for Health Sciences, Medical Informatics and Technology, A-6060 Hall i.T., Austria"},{"name":"Division of Health Technology Assessment and Bioinformatics, ONCOTYROL-Center for Personalized Cancer Medicine, A-6010 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annette","family":"Conrads-Frank","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT\u2014University for Health Sciences, Medical Informatics and Technology, A-6060 Hall i.T., Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L\u00e1ra R.","family":"Hallsson","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT\u2014University for Health Sciences, Medical Informatics and Technology, A-6060 Hall i.T., Austria"},{"name":"Division of Health Technology Assessment and Bioinformatics, ONCOTYROL-Center for Personalized Cancer Medicine, A-6010 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nora","family":"Pashayan","sequence":"additional","affiliation":[{"name":"Department of Applied Health Research, University College London, London WC1E 6BS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7778-8380","authenticated-orcid":false,"given":"Martin","family":"Widschwendter","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s Cancer, University College London, London WC1E 6BS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uwe","family":"Siebert","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT\u2014University for Health Sciences, Medical Informatics and Technology, A-6060 Hall i.T., Austria"},{"name":"Division of Health Technology Assessment and Bioinformatics, ONCOTYROL-Center for Personalized Cancer Medicine, A-6010 Innsbruck, Austria"},{"name":"Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA"},{"name":"Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1016\/j.ejca.2012.12.027","article-title":"Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012","volume":"49","author":"Ferlay","year":"2013","journal-title":"Eur. J. Cancer"},{"key":"ref_2","first-page":"489","article-title":"An update on the current pharmacotherapy for endometrial cancer","volume":"17","author":"Black","year":"2015","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.ejca.2018.07.005","article-title":"Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018","volume":"103","author":"Ferlay","year":"2018","journal-title":"Eur. J. Cancer"},{"key":"ref_4","first-page":"394","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"Bray","year":"2018","journal-title":"CA: A Cancer J. Clin."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1158\/1055-9965.EPI-04-0871","article-title":"Endometrial Cancer Incidence Trends in Europe: Underlying Determinants and Prospects for Prevention","volume":"14","author":"Bray","year":"2005","journal-title":"Cancer Epidemiology Biomarkers Prev."},{"key":"ref_6","first-page":"13","article-title":"Postmenopausal bleeding should be referred urgently","volume":"256","author":"Newell","year":"2012","journal-title":"Pr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.3310\/hta18540","article-title":"Cost-effectiveness of diagnostic strategies for the management of abnormal uterine bleeding (heavy menstrual bleeding and post-menopausal bleeding): A decision analysis","volume":"18","author":"Cooper","year":"2014","journal-title":"Heal. Technol. Assess."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/S1470-2045(09)70041-5","article-title":"Management of extracolonic tumours in patients with Lynch syndrome","volume":"10","author":"Koornstra","year":"2009","journal-title":"Lancet Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1373\/clinchem.2013.206888","article-title":"Lynch Syndrome Presenting as Endometrial Cancer","volume":"60","author":"Tafe","year":"2014","journal-title":"Clin. Chem."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s10689-004-5811-3","article-title":"The Incidence of Lynch Syndrome","volume":"4","year":"2005","journal-title":"Fam. Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1158\/1940-6207.CAPR-13-0238","article-title":"Chemoprevention of Endometrial Cancer in Lynch Syndrome: A Step Forward","volume":"6","author":"Stoffel","year":"2013","journal-title":"Cancer Prev. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1056\/NEJMoa052627","article-title":"Prophylactic Surgery to Reduce the Risk of Gynecologic Cancers in the Lynch Syndrome","volume":"354","author":"Schmeler","year":"2006","journal-title":"New Engl. J. Med."},{"key":"ref_13","unstructured":"NCI (2016, November 04). Endometrial Cancer Screening Physician Data Query (PDQ), Available online: www.cancer.gov\/cancertopics\/pdq\/screening\/endometrial\/HealthProfessional\/."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1034\/j.1600-0412.2003.00176.x","article-title":"Probability analysis for diagnosis of endometrial hyperplasia and cancer in postmenopausal bleeding: An approach for a rational diagnostic workup","volume":"82","author":"Bachmann","year":"2003","journal-title":"Acta Obstet Gynecol Scand"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1158\/1940-6207.CAPR-10-0262","article-title":"Health benefits and cost-effectiveness of primary genetic screening for Lynch syndrome in the general population","volume":"4","author":"Dinh","year":"2010","journal-title":"Cancer Prev. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1097\/AOG.0000000000001616","article-title":"Levonorgestrel Intrauterine Device as an Endometrial Cancer Prevention Strategy in Obese Women","volume":"128","author":"Dottino","year":"2016","journal-title":"Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"640.e1","DOI":"10.1016\/j.ajog.2009.02.022","article-title":"Cost-effectiveness analysis of annual screening strategies for endometrial cancer","volume":"200","author":"Havrilesky","year":"2009","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1097\/AOG.0b013e31817d53a4","article-title":"Cost-Effectiveness Analysis of Endometrial Cancer Prevention Strategies for Obese Women","volume":"112","author":"Kwon","year":"2008","journal-title":"Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1002\/cncr.23554","article-title":"Cost-effectiveness analysis of prevention strategies for gynecologic cancers in Lynch syndrome","volume":"113","author":"Kwon","year":"2008","journal-title":"Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1007\/s10689-011-9444-z","article-title":"A cost-effectiveness analysis of prophylactic surgery versus gynecologic surveillance for women from hereditary non-polyposis colorectal cancer (HNPCC) Families","volume":"10","author":"Yang","year":"2011","journal-title":"Fam. Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.ygyno.2017.03.025","article-title":"Mortality reduction and cost-effectiveness of performing hysterectomy at the time of risk-reducing salpingo-oophorectomy for prophylaxis against serous\/serous-like uterine cancers in BRCA1 mutation carriers","volume":"145","author":"Havrilesky","year":"2017","journal-title":"Gynecol. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1053\/j.gastro.2010.08.021","article-title":"The PREMM1,2,6 Model Predicts Risk of MLH1, MSH2, and MSH6 Germline Mutations Based on Cancer History","volume":"140","author":"Kastrinos","year":"2011","journal-title":"Gastroenterol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1177\/070674370805300408","article-title":"A clinician\u2019s guide to correct cost-effectiveness analysis: Think incremental not average","volume":"53","author":"Hoch","year":"2008","journal-title":"Can. J. Psychiatry"},{"key":"ref_24","first-page":"1510","article-title":"Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities","volume":"280","author":"Kerlikowske","year":"1998","journal-title":"JAMA"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/S1470-2045(10)70268-0","article-title":"Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: A case-control study within the UKCTOCS cohort","volume":"12","author":"Jacobs","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1002\/uog.1704","article-title":"How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding","volume":"24","author":"Weiss","year":"2004","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3867","DOI":"10.1200\/JCO.2003.10.100","article-title":"Long-Term Psychological Impact of Carrying a BRCA1\/2 Mutation and Prophylactic Surgery: A 5-Year Follow-Up Study","volume":"21","author":"Lodder","year":"2003","journal-title":"J. Clin. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1177\/0272989X12455463","article-title":"State-Transition Modeling","volume":"32","author":"Siebert","year":"2012","journal-title":"Med Decis. Mak."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/s10198-003-0205-2","article-title":"When should decision-analytic modeling be used in the economic evaluation of health care?","volume":"4","author":"Siebert","year":"2003","journal-title":"Eur. J. Heal. Econ."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1177\/0272989X12454577","article-title":"Modeling Good Research Practices\u2014Overview","volume":"32","author":"Caro","year":"2012","journal-title":"Med Decis. Mak."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1177\/0272989X12454941","article-title":"Conceptualizing a Model","volume":"32","author":"Roberts","year":"2012","journal-title":"Med Decis. Mak."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1016\/j.jval.2015.09.2939","article-title":"Beware of Kinked Frontiers: A Systematic Review of the Choice of Comparator Strategies in Cost-Effectiveness Analyses of Human Papillomavirus Testing in Cervical Screening","volume":"18","author":"Naber","year":"2015","journal-title":"Value Heal."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.critrevonc.2018.03.023","article-title":"Prediction models for endometrial cancer for the general population or symptomatic women: A systematic review","volume":"126","author":"Alblas","year":"2018","journal-title":"Crit. Rev. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"f1049","DOI":"10.1136\/bmj.f1049","article-title":"Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement","volume":"346","author":"Husereau","year":"2013","journal-title":"BMJ"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/j.jval.2012.06.012","article-title":"Modeling Good Research Practices\u2014Overview: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force-1","volume":"15","author":"Caro","year":"2012","journal-title":"Value Heal."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1016\/j.jval.2012.06.014","article-title":"State-Transition Modeling: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force-3","volume":"15","author":"Siebert","year":"2012","journal-title":"Value Heal."},{"key":"ref_37","unstructured":"(2020, January 17). OECD Purchasing power parities (PPP). Available online: https:\/\/data.oecd.org\/conversion\/purchasing-power-parities-ppp.htm."},{"key":"ref_38","unstructured":"OECD (2020, January 17). Inflation (CPI) (indicator). Available online: https:\/\/data.oecd.org\/price\/inflation-cpi.htm."},{"key":"ref_39","unstructured":"Siebert, U. (2005). Using decision-analytic modelling to transfer international evidence from health technology assessment to the context of the German health care system. GMS Heal. Technol Assess, 1."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Hunink, M.M., Weinstein, M.C., Wittenberg, E., Drummond, M.F., Pliskin, J.S., Wong, J.B., Glasziou, P.P., and Fineberg, H.V. (2014). Decision Making in Health and Medicine, Cambridge University Press (CUP).","DOI":"10.1017\/CBO9781139506779"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1056\/NEJMp1405158","article-title":"Updating Cost-Effectiveness \u2014 The Curious Resilience of the $50,000-per-QALY Threshold","volume":"371","author":"Neumann","year":"2014","journal-title":"New Engl. J. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"485","DOI":"10.2217\/cer.15.38","article-title":"Systematic overview of cost\u2013effectiveness thresholds in ten countries across four continents","volume":"4","author":"Schwarzer","year":"2015","journal-title":"J. Comp. Eff. Res."},{"key":"ref_43","unstructured":"WHO (2020, January 17). Macroeconomics and health: Investing in health for economic development. Report of the Commission on Macroeconomics and Health. Available online: http:\/\/apps.who.int\/iris\/bitstream\/10665\/42435\/1\/924154550X.pdf.2001."},{"key":"ref_44","unstructured":"WHO (2020, January 17). Choosing interventions that are cost-effective [Internet]. Available online: http:\/\/www.who.int\/choice\/en\/2014."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/12\/7\/1874\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:50:26Z","timestamp":1760176226000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/12\/7\/1874"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,11]]},"references-count":44,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2020,7]]}},"alternative-id":["cancers12071874"],"URL":"https:\/\/doi.org\/10.3390\/cancers12071874","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,11]]}}}