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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.

Author information

1
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.
2
Department of Health Services Research and Policy, 15-17 Tavistock Place, London, WC1H 9SH, UK.
3
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.
4
Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, W1T 7DN, UK. Electronic address: u.menon@ucl.ac.uk.

Abstract

OBJECTIVE:

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

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

KEYWORDS:

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

PMID:
26436478
DOI:
10.1016/j.ygyno.2015.10.001
[Indexed for MEDLINE]

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