eprintid: 1477078
rev_number: 29
eprint_status: archive
userid: 608
dir: disk0/01/47/70/78
datestamp: 2016-07-12 11:45:35
lastmod: 2021-12-13 02:18:52
status_changed: 2016-07-12 11:45:35
type: article
metadata_visibility: show
creators_name: Manchanda, R
creators_name: Legood, R
creators_name: Pearce, L
creators_name: Menon, U
title: Defining the risk threshold for risk reducing salpingo-oophorectomy for ovarian cancer prevention in low risk postmenopausal women
ispublished: pub
divisions: UCL
divisions: B02
divisions: D65
divisions: J38
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
note: 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.
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.
date: 2015-12
date_type: published
official_url: http://dx.doi.org/10.1016/j.ygyno.2015.10.001
oa_status: green
full_text_type: other
language: eng
primo: open
primo_central: open_green
article_type_text: Journal Article
verified: verified_manual
elements_id: 1068083
doi: 10.1016/j.ygyno.2015.10.001
pii: S0090-8258(15)30150-5
lyricists_name: Manchanda, Ranjit
lyricists_name: Menon, Usha
lyricists_id: RMANC30
lyricists_id: UMENO29
actors_name: Manchanda, Ranjit
actors_id: RMANC30
actors_role: owner
full_text_status: public
publication: Gynecologic Oncology
volume: 139
number: 3
pagerange: 487-494
event_location: United States
issn: 1095-6859
citation:        Manchanda, R;    Legood, R;    Pearce, L;    Menon, U;      (2015)    Defining the risk threshold for risk reducing salpingo-oophorectomy for ovarian cancer prevention in low risk postmenopausal women.                   Gynecologic Oncology , 139  (3)   pp. 487-494.    10.1016/j.ygyno.2015.10.001 <https://doi.org/10.1016/j.ygyno.2015.10.001>.       Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/1477078/1/Revised_GO_POSTmen-RRSO_Threshold_HE_anal_vF5-UNMARKED.pdf