TY  - JOUR
KW  - Cancer prevention
KW  -  Cost effectiveness
KW  -  Ovarian neoplasm
KW  -  QALY
KW  -  Risk prediction
KW  -  Risk reducing salpingo-oophorectomy
KW  -  Aged
KW  -  Cost-Benefit Analysis
KW  -  Decision Support Techniques
KW  -  Female
KW  -  Genes
KW  -  BRCA1
KW  -  Genes
KW  -  BRCA2
KW  -  Genotype
KW  -  Health Care Costs
KW  -  Humans
KW  -  Middle Aged
KW  -  Ovarian Neoplasms
KW  -  Ovariectomy
KW  -  Postmenopause
KW  -  Quality-Adjusted Life Years
KW  -  Risk Assessment
KW  -  Risk Factors
KW  -  Salpingectomy
ID  - discovery1477078
N2  - 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.
EP  - 494
AV  - public
Y1  - 2015/12//
TI  - Defining the risk threshold for risk reducing salpingo-oophorectomy for ovarian cancer prevention in low risk postmenopausal women
A1  - Manchanda, R
A1  - Legood, R
A1  - Pearce, L
A1  - Menon, U
JF  - Gynecologic Oncology
SN  - 1095-6859
UR  - http://dx.doi.org/10.1016/j.ygyno.2015.10.001
N1  - 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.
IS  - 3
VL  - 139
SP  - 487
ER  -