"Twenty-three percent of all office visits to a gynecologist in the United States are for abnormal uterine bleeding. Any procedure or test that is able to improve the workup improves it for the physician, patient, and the entire economics of the medical profession," said Dr. Ted Cox in a presentation at the 2003 American College of Obstetricians and Gynecologists (ACOG) meeting in New Orleans.
For this study, the investigators examined data from area hospitals related to the cost for operative procedures, anesthesia, clinic visits, ultrasounds, endometrial biopsies, blood work, pathology, and sonohysterography (SHG) when used in evaluation of abnormal uterine bleeding.
They compared the total cost of the workup using sonohysterography versus the standard workup when vaginal ultrasound revealed an endometrial thickness greater than 5 mm.
SHG can save substantially over older methods For example, a classic workup for postmenopausal uterine bleeding can cost over $7,000. Sonohysterography for postmenopausal bleeding will cost around $890. The in-office procedure only takes approximately 60 minutes, said Cox, citing figures from a CD-ROM that he co-authored ("Triage of Abnormal Uterine Bleeding Utilizing Sonohysterography," www.CookObGyn.com).
"You can perform sonohysterography with great confidence that you're not going to miss any significant lesions," according to Dr. David Gams, Cox’s co-author. "Prior to this research some doctors were recommending hysteroscopy, which adds significant risk."
Sonohysterography can be performed in the office with inexpensive equipment, and may now render blind sampling obsolete. "This is a low-risk, inexpensive procedure to rule out significant disease," Gams continued. Moreover, sonohysterography is relatively easy to learn for those who may have been out of residency for a number of years.
With its 70% cost savings over the standard workups, sonohysterography is a painless, harmless, and very fast test that gives a physician the ability to know if the patient needs to go to the operating room for a DNC, according to Cox. "Sonohysterography is an absolutely integral part of the workup on abnormal uterine bleeding," he said. "To bypass using this would border on negligence."
By Jerry Ingram and Bruce SylvesterAuntMinnie.com contributing writers
June 16, 2003
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