OBJECTIVES

: Ovarian cancer is the seventh most common cancer in females and associated with major health and economic burden for women and the society. We aimed to evaluate the impact of different early-detection strategies for ovarian cancer on long-term clinical and health-economic consequences for the Austrian health care context.

METHODS

: A decision-analytic Markov cohort simulation model was developed and calibrated to predict the natural history of ovarian carcinogenesis. We assessed (1) annual multimodal screening (MMS), (2) annual ultrasound screening (USS), and (3) no screening in a cohort of asymptomatic postmenopausal women during their lifetime. We used Austrian epidemiological cancer data from the Tyrolean Cancer Registry, international literature data for utilities and direct medical costs. Costs were transformed into 2017 Euros via GDP-PPP and CPI. Outcomes included the reduction in cancer mortality, (quality-adjusted) life expectancy, and the discounted incremental cost-effectiveness ratio (ICER in Euro/life-years gained (LYG), or quality-adjusted life-years (QALY)). We adopted the healthcare payer perspective and 3% annual discount rate was applied for costs and effects. A willingness-to-pay threshold of 50,000 Euro/LYG for cost effectiveness was applied. Extensive deterministic sensitivity analyses were performed.

RESULTS

: In the base-case analysis, MMS can be considered a cost-effective strategy with an ICER of 36,600 Euro/LYG. A total of 33% reduction in ovarian cancer associated mortality was achieved by MMS compared to no screening. USS resulted in higher total costs and eight times more false positive cases compared to MMS. The discounted ICERs of MMS exceeded 50,000 Euro/LYG with annual discount rates > 5%, test costs > 75 Euro or when quality of life was considered (ICUR of 62,300 Euro/QALY).

CONCLUSIONS

: Our analyses suggest that annual multimodal screening based on the Risk of Ovarian Cancer Algorithm (ROCA) in postmenopausal asymptomatic women in Austria compared to no screening is likely to be considered cost effective.