Impact of screening test performance and cost on mortality reduction and cost-effectiveness of multimodal ovarian cancer screening

摘要

Ongoing ovarian cancer screening trials are investigating the efficacy of a two-step screening strategy using currently available blood and imaging tests (CA125 and transvaginal sonography [TVS]). Concurrently, efforts to develop new biomarkers and imaging tests seek to improve screening performance beyond its current lim its. This study estimates the mortality reduction, years of life saved and cost-effectiveness achievable by annual multimodal screening using rising CA125 to select women for TVS, and predicts improvements achievable by replacing currently available screening tests with hypothetical counter parts with better performance characteristics. An existing stochastic micro-simulation model is refined and used to screen a virtual cohort of 1 million women from age 45 to 85. Each woman is assigned a detailed disease course and screening results timeline. The pre-clinical behavior of CA125 and TVS is simulated using empirical data derived from clinical trials. Simulations in which the disease incidence and performance characteristics of the screening tests are independently varied are performed in order to evaluate the impact of these factors on overall screening performance and costs. Our results demonstrate that when applied to women at average risk, annual screening using rising CA125 to select women for TVS achieves modest mortality reduction (~13%) and falls with in currently accepted cost-effectiveness guidelines. Screening outcomes are relatively insensitive to second-line test performance and costs. Identification of a first line test that perform s substantially better than CA125 and has similar costs is required in order for screening to reduce ovarian mortality by at least 25% and be reasonably cost-effective.