Economic evaluation of an expert examiner and different ultrasound models in the diagnosis of ovarian cancer

Evelyne M. J. Meys; Lara S. Jeelof; Bram L. T. Ramaekers; Carmen D. Dirksen; Loes F. S. Kooreman; Brigitte F. M. Slangen; Roy F. P. M. Kruitwagen; Toon Van Gorp

doi:10.1016/j.ejca.2018.05.003

Economic evaluation of an expert examiner and different ultrasound models in the diagnosis of ovarian cancer

Evelyne M. J. Meys, Lara S. Jeelof, Bram L. T. Ramaekers, Carmen D. Dirksen, Loes F. S. Kooreman, Brigitte F. M. Slangen, Roy F. P. M. Kruitwagen, Toon Van Gorp^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

The Risk of Malignancy Index (RMI) is commonly used to diagnose adnexal masses. The aim of the present study was to determine the cost-effectiveness of the RMI compared with subjective assessment (SA) by an expert and the following novel ultrasound models:

- Simple rules (SR) added by SA (SR + SA);

- SR with inconclusive results diagnosed as malignant (SR + Mal);

- Logistic Regression model 2 (LR2); and

- Assessment of Different NEoplasias in the adneXa (ADNEX) model.

Cost-effectiveness and budget impact analyses were performed from a societal perspective. A decision tree was constructed, and short-term costs and effects were examined in women with adnexal masses. Sensitivity, specificity and the costs of diagnostic strategies were incorporated. Incremental cost-effectiveness ratios were expressed as costs/additional percentage of correctly diagnosed patients. Probabilistic and deterministic sensitivity analyses were performed.

Effectiveness was highest for SA (90.7% [95% confidence interval = 77.3-100]), with a cost saving of 5.0% (-(sic)398 per patient [-(sic)1403 to 549]) compared with the RMI. The costs of SR + SA were the lowest ((sic)7180 [6072-8436]), resulting in a cost saving of 9.0% (-(sic)709 per patient [-(sic)1628 to 236]) compared with the RMI, with an effectiveness of 89.6% (75.8-100). SR + SA showed the highest probability of being the most cost-effective when willingness-to-pay was

Original language	English
Pages (from-to)	55-64
Number of pages	10
Journal	European Journal of Cancer
Volume	100
DOIs	https://doi.org/10.1016/j.ejca.2018.05.003
Publication status	Published - Sep 2018

Keywords

Cost-effectiveness analysis
Budget impact analysis
Diagnosis
Ovarian cancer
Ultrasound
RMI
subjective assessment
Simple ultrasound-based rules
LR2 model
ADNEX model
EXTERNAL VALIDATION
ADNEXAL MASSES
MULTICENTER
SURGERY
RISK
METAANALYSIS
MALIGNANCY
PATHOLOGY
BENIGN
CA-125

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Cite this

@article{b04bcdab982045b6aa3b7237d98e0ec9,

title = "Economic evaluation of an expert examiner and different ultrasound models in the diagnosis of ovarian cancer",

abstract = "The Risk of Malignancy Index (RMI) is commonly used to diagnose adnexal masses. The aim of the present study was to determine the cost-effectiveness of the RMI compared with subjective assessment (SA) by an expert and the following novel ultrasound models:- Simple rules (SR) added by SA (SR + SA);- SR with inconclusive results diagnosed as malignant (SR + Mal);- Logistic Regression model 2 (LR2); and- Assessment of Different NEoplasias in the adneXa (ADNEX) model.Cost-effectiveness and budget impact analyses were performed from a societal perspective. A decision tree was constructed, and short-term costs and effects were examined in women with adnexal masses. Sensitivity, specificity and the costs of diagnostic strategies were incorporated. Incremental cost-effectiveness ratios were expressed as costs/additional percentage of correctly diagnosed patients. Probabilistic and deterministic sensitivity analyses were performed.Effectiveness was highest for SA (90.7% [95% confidence interval = 77.3-100]), with a cost saving of 5.0% (-(sic)398 per patient [-(sic)1403 to 549]) compared with the RMI. The costs of SR + SA were the lowest ((sic)7180 [6072-8436]), resulting in a cost saving of 9.0% (-(sic)709 per patient [-(sic)1628 to 236]) compared with the RMI, with an effectiveness of 89.6% (75.8-100). SR + SA showed the highest probability of being the most cost-effective when willingness-to-pay wasAlthough SA is the best strategy in terms of diagnostic accuracy, SR + SA might be preferred from a cost-effectiveness perspective. (C) 2018 Elsevier Ltd. All rights reserved.",

keywords = "Cost-effectiveness analysis, Budget impact analysis, Diagnosis, Ovarian cancer, Ultrasound, RMI, subjective assessment, Simple ultrasound-based rules, LR2 model, ADNEX model, EXTERNAL VALIDATION, ADNEXAL MASSES, MULTICENTER, SURGERY, RISK, METAANALYSIS, MALIGNANCY, PATHOLOGY, BENIGN, CA-125",

author = "Meys, {Evelyne M. J.} and Jeelof, {Lara S.} and Ramaekers, {Bram L. T.} and Dirksen, {Carmen D.} and Kooreman, {Loes F. S.} and Slangen, {Brigitte F. M.} and Kruitwagen, {Roy F. P. M.} and {Van Gorp}, Toon",

year = "2018",

month = sep,

doi = "10.1016/j.ejca.2018.05.003",

language = "English",

volume = "100",

pages = "55--64",

journal = "European Journal of Cancer",

issn = "0959-8049",

publisher = "ELSEVIER SCI LTD",

}

TY - JOUR

T1 - Economic evaluation of an expert examiner and different ultrasound models in the diagnosis of ovarian cancer

AU - Meys, Evelyne M. J.

AU - Jeelof, Lara S.

AU - Ramaekers, Bram L. T.

AU - Dirksen, Carmen D.

AU - Kooreman, Loes F. S.

AU - Slangen, Brigitte F. M.

AU - Kruitwagen, Roy F. P. M.

AU - Van Gorp, Toon

PY - 2018/9

Y1 - 2018/9

N2 - The Risk of Malignancy Index (RMI) is commonly used to diagnose adnexal masses. The aim of the present study was to determine the cost-effectiveness of the RMI compared with subjective assessment (SA) by an expert and the following novel ultrasound models:- Simple rules (SR) added by SA (SR + SA);- SR with inconclusive results diagnosed as malignant (SR + Mal);- Logistic Regression model 2 (LR2); and- Assessment of Different NEoplasias in the adneXa (ADNEX) model.Cost-effectiveness and budget impact analyses were performed from a societal perspective. A decision tree was constructed, and short-term costs and effects were examined in women with adnexal masses. Sensitivity, specificity and the costs of diagnostic strategies were incorporated. Incremental cost-effectiveness ratios were expressed as costs/additional percentage of correctly diagnosed patients. Probabilistic and deterministic sensitivity analyses were performed.Effectiveness was highest for SA (90.7% [95% confidence interval = 77.3-100]), with a cost saving of 5.0% (-(sic)398 per patient [-(sic)1403 to 549]) compared with the RMI. The costs of SR + SA were the lowest ((sic)7180 [6072-8436]), resulting in a cost saving of 9.0% (-(sic)709 per patient [-(sic)1628 to 236]) compared with the RMI, with an effectiveness of 89.6% (75.8-100). SR + SA showed the highest probability of being the most cost-effective when willingness-to-pay wasAlthough SA is the best strategy in terms of diagnostic accuracy, SR + SA might be preferred from a cost-effectiveness perspective. (C) 2018 Elsevier Ltd. All rights reserved.

AB - The Risk of Malignancy Index (RMI) is commonly used to diagnose adnexal masses. The aim of the present study was to determine the cost-effectiveness of the RMI compared with subjective assessment (SA) by an expert and the following novel ultrasound models:- Simple rules (SR) added by SA (SR + SA);- SR with inconclusive results diagnosed as malignant (SR + Mal);- Logistic Regression model 2 (LR2); and- Assessment of Different NEoplasias in the adneXa (ADNEX) model.Cost-effectiveness and budget impact analyses were performed from a societal perspective. A decision tree was constructed, and short-term costs and effects were examined in women with adnexal masses. Sensitivity, specificity and the costs of diagnostic strategies were incorporated. Incremental cost-effectiveness ratios were expressed as costs/additional percentage of correctly diagnosed patients. Probabilistic and deterministic sensitivity analyses were performed.Effectiveness was highest for SA (90.7% [95% confidence interval = 77.3-100]), with a cost saving of 5.0% (-(sic)398 per patient [-(sic)1403 to 549]) compared with the RMI. The costs of SR + SA were the lowest ((sic)7180 [6072-8436]), resulting in a cost saving of 9.0% (-(sic)709 per patient [-(sic)1628 to 236]) compared with the RMI, with an effectiveness of 89.6% (75.8-100). SR + SA showed the highest probability of being the most cost-effective when willingness-to-pay wasAlthough SA is the best strategy in terms of diagnostic accuracy, SR + SA might be preferred from a cost-effectiveness perspective. (C) 2018 Elsevier Ltd. All rights reserved.

KW - Cost-effectiveness analysis

KW - Budget impact analysis

KW - Diagnosis

KW - Ovarian cancer

KW - Ultrasound

KW - RMI

KW - subjective assessment

KW - Simple ultrasound-based rules

KW - LR2 model

KW - ADNEX model

KW - EXTERNAL VALIDATION

KW - ADNEXAL MASSES

KW - MULTICENTER

KW - SURGERY

KW - RISK

KW - METAANALYSIS

KW - MALIGNANCY

KW - PATHOLOGY

KW - BENIGN

KW - CA-125

U2 - 10.1016/j.ejca.2018.05.003

DO - 10.1016/j.ejca.2018.05.003

M3 - Article

VL - 100

SP - 55

EP - 64

JO - European Journal of Cancer

JF - European Journal of Cancer

SN - 0959-8049

ER -