OA: Cost-effectiveness of screening for ovarian cancer amongst postmenopausal women ((UKCTOCS)

Cost-effectiveness of screening for ovarian cancer amongst postmenopausal women: a model-based economic evaluation | BMC Medicine | Full Text
 

A limitation of our study was the lack of age and stage breakdowns for both the incidence of, and mortality from, ovarian cancer. This limited the analysis in that it was not possible to use the trial evidence to understand the natural history of ovarian cancer and thus to estimate the potential cost-effectiveness of alternative screening strategies, such as different screening intervals or different age ranges.

Background

The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) was the biggest ovarian cancer screening trial to date. A non-significant effect of screening on ovarian cancer was reported, but the authors noted a potential delayed effect of screening, and suggested the need for four years further follow-up. There are no UK-based cost-effectiveness analyses of ovarian cancer screening. Hence we assessed the lifetime outcomes associated with, and the cost-effectiveness of, screening for ovarian cancer in the UK, along with the value of further research.

 

Methods

We performed a model-based economic evaluation. Effectiveness data were taken from UKCTOCS, which considered strategies of multimodal screening (MMS), ultrasound screening (USS) and no screening. We conducted systematic reviews to identify the remaining model inputs, and performed a rigorous and transparent prospective evaluation of different methods for extrapolating the effect of screening on ovarian cancer mortality. We considered costs to the UK healthcare system and measured effectiveness using quality-adjusted life years (QALYs). We used value of information methods to estimate the value of further research.

 

Conclusions

Screening for ovarian cancer with MMS is both more effective and more expensive than not screening. Compared to national willingness to pay thresholds, lifetime cost-effectiveness is promising, but there remains considerable uncertainty regarding extrapolated long-term effectiveness.