Abstract
Background:To assess the within-trial cost-effectiveness of an NHS ovarian cancer screening (OCS) programme using data from UKCTOCS and extrapolate results based on average life expectancy.Methods:Within-trial economic evaluation of no screening (C) vs either (1) an annual OCS programme using transvaginal ultrasound (USS) or (2) an annual ovarian cancer multimodal screening programme with serum CA125 interpreted using a risk algorithm (ROCA) and transvaginal ultrasound as a second-line test (MMS), plus comparison of lifetime extrapolation of the no screening arm and the MMS programme using both a predictive and a Markov model.Results:Using a CA125–ROCA cost of £20, the within-trial results show USS to be strictly dominated by MMS, with the MMS vs C comparison returning an incremental cost-effectiveness ratio (ICER) of £91 452 per life year gained (LYG). If the CA125–ROCA unit cost is reduced to £15, the ICER becomes £77 818 per LYG. Predictive extrapolation over the expected lifetime of the UKCTOCS women returns an ICER of £30 033 per LYG, while Markov modelling produces an ICER of £46 922 per QALY.Conclusion:Analysis suggests that, after accounting for the lead time required to establish full mortality benefits, a national OCS programme based on the MMS strategy quickly approaches the current NICE thresholds for cost-effectiveness when extrapolated out to lifetime as compared with the within-trial ICER estimates. Whether MMS could be recommended on economic grounds would depend on the confirmation and size of the mortality benefit at the end of an ongoing follow-up of the UKCTOCS cohort.
Highlights
To assess the within-trial cost-effectiveness of an National Health Service (NHS) ovarian cancer screening (OCS) programme using data from UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and extrapolate results based on average life expectancy
Using a CA125–risk of ovarian cancer algorithm (ROCA) cost of d20, the within-trial results show ultrasound screening (USS) to be strictly dominated by MMS, with the MMS vs C comparison returning an incremental cost-effectiveness ratio (ICER) of d91 452 per life year gained (LYG)
Analysis suggests that, after accounting for the lead time required to establish full mortality benefits, a national OCS programme based on the MMS strategy quickly approaches the current National Institute of Clinical Excellence (NICE) thresholds for cost-effectiveness when extrapolated out to lifetime as compared with the within-trial ICER estimates
Summary
The primary aim of this paper is to draw on the clinical results arising from the mortality reduction seen in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) to estimate a within-trial period incremental cost-effectiveness ratio (ICER) to assess the value to the UK National Health Service (NHS)-covered population from the initiation of two screening scenarios as
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