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Gynecol Oncol. 2015 Dec;139(3):487-94. doi: 10.1016/j.ygyno.2015.10.001. Epub 2015 Oct 5.

Defining the risk threshold for risk reducing salpingo-oophorectomy for ovarian cancer prevention in low risk postmenopausal women.

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Department of Gynaecological Oncology, St Bartholomew's Hospital, London, EC1A 7BE, UK; Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, W1T 7DN, UK; Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
Department of Health Services Research and Policy, 15-17 Tavistock Place, London, WC1H 9SH, UK.
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA.
Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, W1T 7DN, UK. Electronic address:



To define risk thresholds for cost-effectiveness of risk-reducing salpingo-oophorectomy (RRSO) for ovarian cancer (OC) prevention in low/intermediate risk postmenopausal women.


A decision-analytic model compares lifetime costs-&-effects of offering 'RRSO' with 'no RRSO' to postmenopausal women ≥50years for different lifetime OC-risk thresholds: 2%, 4%, 5%, 6%, 8% and 10%. Well established data from the literature are used to estimate total costs, effects in terms of Quality-Adjusted-Life-Years(QALYs), cancer incidence, incremental cost-effectiveness ratio(ICER) and impact. Costs are reported at 2012 prices; costs/outcomes discounted at 3.5%. Deterministic/probabilistic sensitivity analysis (PSA) evaluate model uncertainty.


RRSO does not save QALYs and is not cost-effective at the 2% general population lifetime OC-risk. At 4% OC-risk RRSO saves QALYs but is not cost-effective. At risk thresholds ≥5%, RRSO saves more life-years and QALYs and is highly cost-effective. The ICERs for OC-risk levels 5%, 6%, 8% and 10% are £15,247, £9958, £4584, and £1864 respectively. The gain in life-years from RRSO equates to 29.2, 40.1, 62.1 and 80.3days at risk thresholds of 5%, 6%, 8% and 10% respectively. The results are not sensitive to treatment costs of RRSO/OC/cardiovascular events but are sensitive to utility-scores for RRSO. On PSA, 67%, 80%, 84%, 91% and 94% of simulations at risk thresholds of 4%, 5%, 6%, 8% and 10% respectively are cost-effective for RRSO.


RRSO is highly cost-effective in postmenopausal women aged >50 with ≥5% lifetime OC-risk and increases life-expectancy by ≥29.2days. The results could have significant clinical implications given the improvements in risk prediction and falling costs of genotyping.


Cancer prevention; Cost effectiveness; Ovarian neoplasm; QALY; Risk prediction; Risk reducing salpingo-oophorectomy

[Indexed for MEDLINE]

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