Defining the risk threshold for risk reducing salpingo-oophorectomy for ovarian cancer prevention in low risk postmenopausal women

作者：Manchanda Ranjit; Legood Rosa; Pearce Leigh; Menon Usha^*

来源：Gynecologic Oncology, 2015, 139(3): 487-494.

DOI：10.1016/j.ygyno.2015.10.001

• Cancer prevention
• Ovarian neoplasm
• Risk reducing salpingo-oophorectomy
• QALY
• Risk prediction
• Cost effectiveness

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 >= 50 years 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 pound, 9958 pound, 4584 pound, and 1864 respectively. The gain in life-years from RRSO equates to 29.2, 40.1, 62.1 and 80.3 days 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 >= 29.2 days. The results could have significant clinical implications given the improvements in risk prediction and falling costs of genotyping.

• 出版日期2015-12