Defining the risk threshold for risk reducing salpingo-oophorectomy for ovarian cancer prevention in low risk postmenopausal women.
dc.contributor.author | Manchanda, R | en_US |
dc.contributor.author | Legood, R | en_US |
dc.contributor.author | Pearce, L | en_US |
dc.contributor.author | Menon, U | en_US |
dc.date.accessioned | 2016-01-19T13:33:12Z | |
dc.date.available | 2015-10-01 | en_US |
dc.date.issued | 2015-12 | en_US |
dc.date.submitted | 2015-12-17T15:17:16.103Z | |
dc.identifier.uri | http://qmro.qmul.ac.uk/xmlui/handle/123456789/10775 | |
dc.description.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. | en_US |
dc.description.sponsorship | The study is not funded by any charity or grant. | en_US |
dc.format.extent | 487 - 494 | en_US |
dc.language | eng | en_US |
dc.language.iso | en | en_US |
dc.relation.ispartof | Gynecol Oncol | en_US |
dc.rights | © 2015. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ | |
dc.subject | Cancer prevention | en_US |
dc.subject | Cost effectiveness | en_US |
dc.subject | Ovarian neoplasm | en_US |
dc.subject | QALY | en_US |
dc.subject | Risk prediction | en_US |
dc.subject | Risk reducing salpingo-oophorectomy | en_US |
dc.subject | Aged | en_US |
dc.subject | Cost-Benefit Analysis | en_US |
dc.subject | Decision Support Techniques | en_US |
dc.subject | Female | en_US |
dc.subject | Genes, BRCA1 | en_US |
dc.subject | Genes, BRCA2 | en_US |
dc.subject | Genotype | en_US |
dc.subject | Health Care Costs | en_US |
dc.subject | Humans | en_US |
dc.subject | Middle Aged | en_US |
dc.subject | Ovarian Neoplasms | en_US |
dc.subject | Ovariectomy | en_US |
dc.subject | Postmenopause | en_US |
dc.subject | Quality-Adjusted Life Years | en_US |
dc.subject | Risk Assessment | en_US |
dc.subject | Risk Factors | en_US |
dc.subject | Salpingectomy | en_US |
dc.title | Defining the risk threshold for risk reducing salpingo-oophorectomy for ovarian cancer prevention in low risk postmenopausal women. | en_US |
dc.type | Article | |
dc.rights.holder | Copyright © 2015 Elsevier Inc. All rights reserved. | |
dc.identifier.doi | 10.1016/j.ygyno.2015.10.001 | en_US |
pubs.author-url | https://www.ncbi.nlm.nih.gov/pubmed/26436478 | en_US |
pubs.issue | 3 | en_US |
pubs.notes | Not known | en_US |
pubs.publication-status | Published | en_US |
pubs.volume | 139 | en_US |
dcterms.dateAccepted | 2015-10-01 | en_US |