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

• Published in: European journal of cancer (1990) 2018-09, Vol.100, p.55-64
• Main Authors: Meys, Evelyne M.J., Jeelof, Lara S., Ramaekers, Bram L.T., Dirksen, Carmen D., Kooreman, Loes F.S., Slangen, Brigitte F.M., Kruitwagen, Roy F.P.M., Van Gorp, Toon
• Format: Article
• Language: English
• Subjects: Absenteeism; ADNEX model; Budget impact analysis; Budgets; Confidence intervals; Construction costs; Cost analysis; Cost engineering; Cost-Benefit Analysis; Cost-effectiveness analysis; Decision analysis; Decision Support Techniques; Decision Trees; Diagnosis; Diagnostic Errors - economics; Diagnostic systems; Economic models; Female; Health Care Costs; Health Expenditures; Health risks; Humans; Impact analysis; LR2 model; Malignancy; Medical diagnosis; Medical treatment; Models, Economic; Netherlands - epidemiology; Ovarian cancer; Ovarian Neoplasms - diagnostic imaging; Ovarian Neoplasms - economics; Ovarian Neoplasms - epidemiology; Ovarian Neoplasms - pathology; Patients; Predictive Value of Tests; Prevalence; Regression analysis; Regression models; Reproducibility of Results; RMI; Sensitivity; Sensitivity analysis; Sick Leave - economics; Simple ultrasound-based rules; Statistical analysis; Studies; Subjective assessment; Ultrasonic imaging; Ultrasonography - economics; Ultrasound
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2018.05.003

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% (−€398 per patient [−€1403 to 549]) compared with the RMI. The costs of SR + SA were the lowest (€7180 [6072–8436]), resulting in a cost saving of 9.0% (−€709 per patient [−€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