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 journalArticleAcademicpeer-review

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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

Although 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.

Original languageEnglish
Pages (from-to)55-64
Number of pages10
JournalEuropean Journal of Cancer
Publication statusPublished - Sept 2018


  • Cost-effectiveness analysis
  • Budget impact analysis
  • Diagnosis
  • Ovarian cancer
  • Ultrasound
  • RMI
  • subjective assessment
  • Simple ultrasound-based rules
  • LR2 model
  • ADNEX model
  • RISK
  • CA-125


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