Document Detail


Impact of screening test performance and cost on mortality reduction and cost-effectiveness of multimodal ovarian cancer screening.
MedLine Citation:
PMID:  22750949     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 limits. This study estimates the mortality reduction, years of life saved, and cost-effectiveness achievable by annual multimodal screening using increasing CA125 to select women for TVS, and predicts improvements achievable by replacing currently available screening tests with hypothetical counterparts with better performance characteristics. An existing stochastic microsimulation model is refined and used to screen a virtual cohort of 1 million women from ages 45 to 85 years. Each woman is assigned a detailed disease course and screening results timeline. The preclinical 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 conducted to evaluate the impact of these factors on overall screening performance and costs. Our results show that when applied to women at average risk, annual screening using increasing CA125 to select women for TVS achieves modest mortality reduction (~13%) and meets currently accepted cost-effectiveness guidelines. Screening outcomes are relatively insensitive to second-line test performance and costs. Identification of a first-line test that does substantially better than CA125 and has similar costs is required for screening to reduce ovarian mortality by at least 25% and be reasonably cost-effective.
Authors:
Charles W Drescher; Sarah Hawley; Jason D Thorpe; Simone Marticke; Martin McIntosh; Sanjiv S Gambhir; Nicole Urban
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-07-02
Journal Detail:
Title:  Cancer prevention research (Philadelphia, Pa.)     Volume:  5     ISSN:  1940-6215     ISO Abbreviation:  Cancer Prev Res (Phila)     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-08-07     Completed Date:  2012-12-20     Revised Date:  2013-08-13    
Medline Journal Info:
Nlm Unique ID:  101479409     Medline TA:  Cancer Prev Res (Phila)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1015-24     Citation Subset:  IM    
Affiliation:
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98104, USA. cdresche@fhcrc.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
CA-125 Antigen / blood
Cost-Benefit Analysis
Disease Progression
Early Detection of Cancer / economics*,  mortality*
Female
Humans
Middle Aged
Neoplasms, Glandular and Epithelial / diagnosis*,  economics,  mortality*
Ovarian Neoplasms / diagnosis*,  economics,  mortality*
Predictive Value of Tests
Risk Factors
Survival Rate
Grant Support
ID/Acronym/Agency:
P50 CA083636/CA/NCI NIH HHS; P50 CA083636/CA/NCI NIH HHS; U01 CA152637/CA/NCI NIH HHS
Chemical
Reg. No./Substance:
0/CA-125 Antigen
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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