Pre-operative cross-sectional imaging of chest, abdomen, pelvis is not cost-effective for low-grade endometrial cancer
Increasing numbers of patients are presenting with metastatic burden of endometrial cancer. Currently, guidelines recommend that pre-operative imaging for surgical planning be guided by patient symptoms, risk assessment, and clinical suspicion for disease. Cross-sectional computerized tomography (CT) imaging is not recommended for low-grade disease due to the low risk of distant spread in this group; however, longitudinal data has demonstrated a marked increase in the utilization of preoperative CT imaging in this patient population over the last decade. In this cost-effectiveness analysis, a decision analytic model was made to compare the utility of pre-operative CT imaging versus standard-of-care transvaginal ultrasound (TVUS) in low-risk patients with presumed grade 1-2 endometrioid endometrial cancer. Costs adjusted for 2025 $USD healthcare perspective and quality-adjusted life years (QALY) were inputted into the model. A probabilistic sensitivity analysis (PSA) nested within a Monte Carlo simulation was used to assess outcomes over 5-years. The mean cost in the CT imaging arm was marginally increased compared to undergoing care in the TVUS arm: $41,462 (95% CI $41,407-41,517) versus $40,144 (95% CI $40,104-40,184). In addition, CT imaging had nominally lower quality of life (3.92 QALY versus 4.05 QALY). Overall, foregoing CT imaging results in a higher incremental net monetary benefit ($14,716) compared to performing CT imaging. Routine addition of CT imaging for pre-operative evaluation in low-risk endometrial cancer does not represent a value-based use of healthcare resources.