@article{discovery1477078,
          number = {3},
            year = {2015},
           month = {December},
         journal = {Gynecologic Oncology},
           pages = {487--494},
           title = {Defining the risk threshold for risk reducing salpingo-oophorectomy for ovarian cancer prevention in low risk postmenopausal women},
          volume = {139},
            note = {Copyright {\copyright} 2015. This manuscript version is published under a Creative Commons Attribution Non-commercial Non-derivative 4.0 International licence (CC BY-NC-ND 4.0). This licence allows you to share, copy, distribute and transmit the work for personal and non-commercial use providing author and publisher attribution is clearly stated. Further details about CC BY licences are available at http://creativecommons.org/licenses/by/4.0.},
        keywords = {Cancer prevention, Cost effectiveness, Ovarian neoplasm, QALY, Risk prediction, Risk reducing salpingo-oophorectomy, Aged, Cost-Benefit Analysis, Decision Support Techniques, Female, Genes, BRCA1, Genes, BRCA2, Genotype, Health Care Costs, Humans, Middle Aged, Ovarian Neoplasms, Ovariectomy, Postmenopause, Quality-Adjusted Life Years, Risk Assessment, Risk Factors, Salpingectomy},
        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 {$\ge$}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 {$\ge$}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 {\pounds}15,247, {\pounds}9958, {\pounds}4584, and {\pounds}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 {\ensuremath{>}}50 with {$\ge$}5\% lifetime OC-risk and increases life-expectancy by {$\ge$}29.2days. The results could have significant clinical implications given the improvements in risk prediction and falling costs of genotyping.},
             url = {http://dx.doi.org/10.1016/j.ygyno.2015.10.001},
            issn = {1095-6859},
          author = {Manchanda, R and Legood, R and Pearce, L and Menon, U}
}