Artikel
Long-term effectiveness and cost-effectiveness of ovarian cancer screening in Austria
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Veröffentlicht: | 6. März 2018 |
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Gliederung
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Background/Objective: Ovarian cancer is the seventh most common cancer in females in developed countries and associated with major burden for the individual woman and the society. We aimed to evaluate the impact of different screening strategies for ovarian cancer on long-term clinical and health-economic consequences for the Austrian health care context.
Methods: We developed and calibrated a Markov state transition model simulating the natural history of ovarian cancer development for the Austrian epidemiological and clinical context. The model evaluates the long-term effectiveness and cost-effectiveness of (1) annual multimodal screening (MMS) or (2) annual ultrasound screening (USS) compared to (3) no screening in a cohort of asymptomatic postmenopausal women during their lifetime. Austrian epidemiological cancer data from the Tyrolean cancer registry and Statistics Austria as well as international literature data for quality-of-life(QoL) and direct medical costs were used. Costs were transformed into 2016 Euros GDP-PPP and CPI. Outcomes included the reduction in cancer mortality, remaining life expectancy and quality-adjusted life expectancy, lifetime costs, and the discounted incremental cost-effectiveness ratio (ICER in Euro/LYG or QALYG). We adopted a health care payer perspective and applied 5% annual discount rate for costs and effects. Extensive deterministic sensitivity analyses were performed.
Results: In the base-case analysis, compared to no screening both MMS and USS achieved a 34% reduction in lifetime risk to die from ovarian cancer. MMS was the most effective strategy in terms of remaining life expectancy and yielded an ICER of 46,000 Euro/LYG compared to no screening, which can be considered cost-effective assuming a willingness-to-pay of 50,000 Euro/LYG. USS resulted in more false positive cases compared to MMS. Eleven women would need to undergo unnecessary oophorectomy in order to prevent one ovarian cancer death in the USS arm compared with three women in the MMS arm. However, results were affected when varying relevant model parameters. In sensitivity analyses, MMS was not cost-effective anymore with test costs exceeding 57 Euro and when QoL data were considered (51,000 Euro/QALYG).
Conclusions: Our analyses suggest that annual multimodal screening in postmenopausal asymptomatic women in Austria compared to no screening is likely to be considered cost-effective. Further research is needed to inform on screening related work-up and costs as well as on Qol reduction from oophorectomy.
Acknowledgement: We thank the Erasmus-Western Balkans mobility programme (ERAWEB), a project funded by the European Commission, for funding student exchange program.
Funding: This work was partly funded by the European Union’s Horizon 2020 research and innovation programme project FORECEE (4C) that received funding under grant agreement number 634570 and The Eve Appeal. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.