Is Screening for Ovarian Cancer Cost-Effective?

Screening for ovarian cancer can be important to many women who are at risk, but some wonder what the levels of cost-effectiveness are. It has been found that multimodal screening is a more costly option; however, it is able to decrease the levels of ovarian cancer mortality.

Multimodal screening

Multimodal screening, or MMS, is a way of testing and diagnosing women who may have ovarian cancer.

On top of its importance regarding the effect on women's health, a study has recently been found to show that it may be considered cost-effective within the United States.

For more information on the study, it is available online in Jama Oncology.

The study

Haley A. Moss, M.D., of Duke University in Durham, North Carolina, set out with her colleagues to analyze how cost-effective MMS is across the nation. Their outcomes were to analyze the cost, mortality reduction resulting from such a screening, and how many quality-adjusted life-years (QALYs) would be added, if any. To do so, they created a Markov simulation model to analyze MMS (starting in those fifty years of age) in comparison to no such screening.

Initial costs include an ultrasound, false-positive work-up results, risk algorithm, and CA-125, and these add up to around $100.

Data was used from UKCTOCS to facilitate the comparison. In order to participate, those involved in the study had to be at least fifty years old (most often, women at the highest risk are asymptomatic postmenopausal women). 46,237 women were screened by looking into CA-125 regarding a risk of ovarian cancer algorithm, or ROCA. This algorithm was able to interpret alterations within the CA-125, which showed to be useful in analyzing a personal risk of developing the condition, even well into the future.

What makes this method different than the more traditional screening methods? Normally, a cut-off point is fixed when analyzing CA-125, but MMS is able to analyze fluctuations in these levels, offering a more personal and precise insight.

The estimates of the long-term efficacy of the screenings and the published hazard ratios were able to offer insight into morality up to forty years after the beginning of screening.

Of course, it was important for varying screening strategies, costs of the algorithm, and alternate forms of treatment to be analyzed in addition to compliance regarding screening, and the ovarian cancer incidence itself.

This was the largest yet randomized clinical trial that set out to analyze how screenings impact the mortality rate of those with ovarian cancer.

Results

These researchers discovered that MMS is significantly more effective in protecting women from dying of ovarian cancer than if they had not been screened. It is more expensive, but the effect on morbidity is sizable. Normally, fewer than 30% of those who are diagnosed with ovarian cancer will survive for even five years. However, early detection is able to increase this rate, and as treatment is much more effective in the earlier stages of the cancer. However, once the cancer has surpassed a certain phase, it can become nearly impossible to control. By tracking certain elevations of CA-125, a diagnosis or at least an increased risk can be confirmed years before the typical signs of ovarian cancer appear, meaning that women can be diligent with their treatment and screening - meaning not only that their projected lifespan may increase, but also they may be able to avoid significant pain and suffering associated with the cancer.

Read on to learn more about this groundbreaking research.