The cost-effectiveness of screening for ovarian cancer: results from the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

Menion, Usha, McGuire, Alistair, Raikou, Maria, Ryan, Andy, Davies, Susan, Burnell, Matthew, Gentry-Maharaj, Aleksandra, Kalsi, Jatinderpal, Singh, Naveena, Amso, Nazar, Cruickshank, Derek, Dobbs, Stephen, Godfrey, Keith, Herod, Jonathan, Leeson, Simon, Mould, Tim, Murdoch, John, Oram, David, Scott, Ian, Seif, Mourad, Williamson, Karin, Woolas, Robert, Fallowfield, Lesley, Campbell, Stuart, Skates, Steven, Parmar, Mahesh and Jacobs, Ian (2017) The cost-effectiveness of screening for ovarian cancer: results from the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). British Journal of Cancer, 117. pp. 619-627. ISSN 0007-0920

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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) versus 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 versus 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.

Conclusions: 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 to 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.

Item Type: Article
Keywords: Ovarian Cancer screening, UKCTOCS, cost-effectiveness, randomised controlled trial, CA125, TVS
Schools and Departments: Brighton and Sussex Medical School > Sussex Health Outcomes Research & Education in Cancer (SHORE-C)
Subjects: R Medicine > R Medicine (General) > R728 Practice of medicine. Medical practice economics
R Medicine > R Medicine (General) > R852 Research. Experimentation > R853.C55 Clinical trials
R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology Including cancer and carcinogens
Depositing User: Kathryn Monson
Date Deposited: 09 Jun 2017 12:22
Last Modified: 25 Aug 2017 02:35
URI: http://sro.sussex.ac.uk/id/eprint/68457

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Project NameSussex Project NumberFunderFunder Ref
UKCTOCSUnsetMedical Research CouncilUnset