Cost-effectiveness of routine vaginal cytology for endometrial cancer surveillance

Objective.: To examine the cost-effectiveness of routine vaginal cytology in detecting asymptomatic isolated vaginal recurrence during post-treatment endometrial cancer surveillance. Methods.: All patients treated for endometrial cancer between 7/1/97 and 6/30/2005 were retrospectively identified from the tumor registry database. Clinico-pathologic characteristics and surveillance testing data were abstracted from medical records. The total number of Pap tests performed during surveillance or until the time of recurrence was calculated and charges associated with detecting asymptomatic isolated vaginal recurrence assigned based on 2005 Pap test costs adjusted retroactively using the consumer price index. Results.: Three hundred seventy-seven patients met inclusion criteria: FIGO Stage I = 63.7%, Stage II = 10.1%, Stage III = 18.8%, Stage IV = 7.4%. The median follow-up time was 30.4 months. A total of 2134 Pap tests were collected during the study interval (median 5, mean 5.76 samples/patient). Endometrial cancer recurred in 61 patients (16.2%); 11 patients (2.9%) had an isolated vaginal recurrence. Seven isolated vaginal recurrences were detected by physical examination alone, and 2 were detected by interval computed tomography. An asymptomatic isolated vaginal recurrence was detected by routine vaginal cytology in 2 of 377 patients (0.5%). Detection of each asymptomatic vaginal recurrence required 1067 Pap tests, generating $44,049 in cumulative charges. Conclusions.: As a surveillance test for endometrial cancer recurrence, routine vaginal cytology is costly, inefficient, and benefits less than 1% of patients. Elimination or reduction in the use of vaginal cytology for this purpose offers an opportunity for significant cost savings in gynecologic oncology health care expenditure.