OBJECTIVES: The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) evaluated the effectiveness of two ovarian cancer screening strategies: multimodal screening and ultrasound screening. This paper investigates the cost-effectiveness and distributional consequences of these interventions in England using a distributional cost-effectiveness analysis (DCEA).

METHODS: An existing distributionally naïve cohort-level Markov model of UKCTOCS was adapted to conduct the DCEA. A systematic literature review was conducted to identify and incorporate socioeconomic variation in model inputs. The impact of screening on net health was estimated for each socioeconomic quintile. Social welfare analysis was conducted to evaluate changes in total population health and health inequality. Sensitivity to the cost of foregone QALYs, and the extent of inequality aversion, was assessed. The impact of excluding socioeconomic variation in different parameters on the results was explored in scenario analyses.

RESULTS: Multimodal screening produced a positive incremental population net health benefit compared to ‘no screening’ [24,332 QALYs]. Ultrasound screening had a net-negative effect [-58,792 QALYs]. Both interventions increased health inequalities. Below an Atkinson aversion parameter of 11, multimodal screening was the optimal strategy. Above this level, no screening was preferred.

CONCLUSIONS: Capturing health inequalities in economic evaluations and providing information of the distributional consequences of interventions can impact conclusions of cost-effectiveness.