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Costs, effectiveness, and workload impact of management strategies for women with an adnexal mass.

Publication ,  Journal Article
Havrilesky, LJ; Dinan, M; Sfakianos, GP; Curtis, LH; Barnett, JC; Van Gorp, T; Myers, ER
Published in: J Natl Cancer Inst
January 2015

BACKGROUND: We compared the estimated clinical outcomes, costs, and physician workload resulting from available strategies for deciding which women with an adnexal mass should be referred to a gynecologic oncologist. METHODS: We used a microsimulation model to compare five referral strategies: 1) American Congress of Obstetricians and Gynecologists (ACOG) guidelines, 2) Multivariate Index Assay (MIA) algorithm, 3) Risk of Malignancy Algorithm (ROMA), 4) CA125 alone with lowered cutoff values to prioritize test sensitivity over specificity, 5) referral of all women (Refer All). Test characteristics and relative survival were obtained from the literature and data from a biomarker validation study. Medical costs were estimated using Medicare reimbursements. Travel costs were estimated using discharge data from Surveillance, Epidemiology and End Results-Medicare and State Inpatient Databases. Analyses were performed separately for pre- and postmenopausal women (60 000 "subjects" in each), repeated 10 000 times. RESULTS: Refer All was cost-effective compared with less expensive strategies in both postmenopausal (incremental cost-effectiveness ratio [ICER] $9423/year of life saved (LYS) compared with CA125) and premenopausal women (ICER $10 644/YLS compared with CA125), but would result in an additional 73 cases/year/subspecialist. MIA was more expensive and less effective than Refer All in pre- and postmenopausal women. If Refer All is not a viable option, CA125 is an optimal strategy in postmenopausal women. CONCLUSIONS: Referral of all women to a subspecialist is an efficient strategy for managing women with adnexal masses requiring surgery, assuming sufficient capacity for additional surgical volume. If a test-based triage strategy is needed, CA125 with lowered cutoff values is a cost-effective strategy.

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Published In

J Natl Cancer Inst

DOI

EISSN

1460-2105

Publication Date

January 2015

Volume

107

Issue

1

Start / End Page

322

Location

United States

Related Subject Headings

  • Workload
  • United States
  • Sensitivity and Specificity
  • SEER Program
  • Risk Assessment
  • Referral and Consultation
  • Premenopause
  • Practice Guidelines as Topic
  • Postmenopause
  • Oncology & Carcinogenesis
 

Citation

APA
Chicago
ICMJE
MLA
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Havrilesky, L. J., Dinan, M., Sfakianos, G. P., Curtis, L. H., Barnett, J. C., Van Gorp, T., & Myers, E. R. (2015). Costs, effectiveness, and workload impact of management strategies for women with an adnexal mass. J Natl Cancer Inst, 107(1), 322. https://doi.org/10.1093/jnci/dju322
Havrilesky, Laura J., Michaela Dinan, Gregory P. Sfakianos, Lesley H. Curtis, Jason C. Barnett, Toon Van Gorp, and Evan R. Myers. “Costs, effectiveness, and workload impact of management strategies for women with an adnexal mass.J Natl Cancer Inst 107, no. 1 (January 2015): 322. https://doi.org/10.1093/jnci/dju322.
Havrilesky LJ, Dinan M, Sfakianos GP, Curtis LH, Barnett JC, Van Gorp T, et al. Costs, effectiveness, and workload impact of management strategies for women with an adnexal mass. J Natl Cancer Inst. 2015 Jan;107(1):322.
Havrilesky, Laura J., et al. “Costs, effectiveness, and workload impact of management strategies for women with an adnexal mass.J Natl Cancer Inst, vol. 107, no. 1, Jan. 2015, p. 322. Pubmed, doi:10.1093/jnci/dju322.
Havrilesky LJ, Dinan M, Sfakianos GP, Curtis LH, Barnett JC, Van Gorp T, Myers ER. Costs, effectiveness, and workload impact of management strategies for women with an adnexal mass. J Natl Cancer Inst. 2015 Jan;107(1):322.
Journal cover image

Published In

J Natl Cancer Inst

DOI

EISSN

1460-2105

Publication Date

January 2015

Volume

107

Issue

1

Start / End Page

322

Location

United States

Related Subject Headings

  • Workload
  • United States
  • Sensitivity and Specificity
  • SEER Program
  • Risk Assessment
  • Referral and Consultation
  • Premenopause
  • Practice Guidelines as Topic
  • Postmenopause
  • Oncology & Carcinogenesis