EP27.04: Cost‐benefit analysis for the use of transvaginal ultrasound to avoid laparoscopy in women with minimal endometriosis disease

15% of women who present to a gynecology clinic have chronic pelvic pain (CPP). Up to 56% of this group will not have underlying pouch of Douglas obliteration, endometriomata or deep infiltrating endometriosis (DIE) when scheduled for routine diagnostic laparoscopy. We aim to estimate the costs of a general gynecologist's conventional surgical approach (model 1) vs medical management following an ultrasound assessment by an expert in DIE diagnosis (model 2) to women with CPP. We compared two models of care: (1) a conventional model whereby general gynecologists seeing women with suspected endometriosis proceed directly to diagnostic laparoscopy without a detailed transvaginal ultrasound (TVS) by an expert in DIE assessment and (2) an approach whereby general gynecologists order a detailed TVS by an expert in DIE assessment and having excluded complex disease do not proceed to laparoscopy but rather insert a Mirena IUS. The costs to the public health system for consultation, ultrasound and various surgical interventions for endometriosis were retrieved from New South Wales Ministry of Health: consultation $A225, detailed ultrasound $A500, diagnostic laparoscopy $A2,541, insertion of Mirena IUS $A255. Calculations of the cost of treating non-complex disease were performed and compared for both clinical pathways. For an outpatient gynecology unit that reviews 1000 new consultations annually, 15% (150/1000) women would present with CPP. Of these 56% (84/150) women would not have underlying POD obliteration with complex endometriosis. With model 1 the cost of treating each non-complex case is $A2,992, whereas for model (2) $A1,430. This means that there is a cost saving of $A1,562 per case or $A131,208 annually. The modern approach to minimal endometriosis using transvaginal ultrasound will lead to a significant cost saving of $A1,562 per case, or $A131,208 per year.