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
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 language | English |
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Pages (from-to) | 55-64 |
Number of pages | 10 |
Journal | European Journal of Cancer |
Volume | 100 |
DOIs | |
Publication status | Published - Sept 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