International journal of gynecological cancer : official journal of the International Gynecological Cancer Society · 2026
Human epididymis protein 4 and risk of malignancy index as risk assessment tools in the decision for referral to an oncology center in patients with an ovarian mass: a cost-effectiveness analysis from a Dutch health care perspective.
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Lof Pien, Koole Simone N, Stiekema Anna, Jansen Myrthe, Fons Guus, Amant Frédéric, van Gent Mignon D J M, Mom Constantijne H, Rosier-van Dunné Fleur M F, van Baal Wilhelmina M, Verhoeve Harold R, Hermsen Brenda B J, Verbruggen Marjolijn B, Hemelaar Majoie, van de Swaluw Jojanneke M G, Knipscheer Haye C, Huirne Judith A F, Westenberg Steven M, Retèl Valesca P, van den Broek Daan, Lok Christianne A R
Аннотация
OBJECTIVE: Human epididymis protein 4 has been shown to be an effective biomarker for detecting early-stage ovarian cancer. However, its cost-effectiveness has not been systematically investigated. Therefore, this study aims to compare the cost-effectiveness of different referral policies in patients with an ovarian mass, based on current practices and the potential use of human epididymis protein 4.
METHODS: A decision-tree health-state transition model was constructed to model costs and outcomes of 4 different referral strategies: human epididymis protein 4 and Risk of Malignancy Index combined, Risk of Malignancy Index alone, referral of all patients, and no referral at all. Costs (€) and outcomes were included with a time horizon of 1 year.
RESULTS: Risk of Malignancy Index + human epididymis protein 4 resulted in the lowest mean costs per patient (€8905, standard deviation -1340), compared to Risk of Malignancy Index (€9,261, standard deviation -1394), referral of all (€10,117, standard deviation -1684), and no referral at all (€9357, standard deviation -1536). The mean quality-adjusted first life year was almost similar among all strategies (ranging from 0.785 to 0.789). Risk of Malignancy Index + human epididymis protein 4 was the most cost-effective in all sensitivity and scenario analyses.
CONCLUSIONS: Risk of Malignancy Index + human epididymis protein 4 is a cost-effective strategy in the referral decision-making process of a general hospital for patients with an ovarian mass, compared to Risk of Malignancy Index alone or no strategy.
METHODS: A decision-tree health-state transition model was constructed to model costs and outcomes of 4 different referral strategies: human epididymis protein 4 and Risk of Malignancy Index combined, Risk of Malignancy Index alone, referral of all patients, and no referral at all. Costs (€) and outcomes were included with a time horizon of 1 year.
RESULTS: Risk of Malignancy Index + human epididymis protein 4 resulted in the lowest mean costs per patient (€8905, standard deviation -1340), compared to Risk of Malignancy Index (€9,261, standard deviation -1394), referral of all (€10,117, standard deviation -1684), and no referral at all (€9357, standard deviation -1536). The mean quality-adjusted first life year was almost similar among all strategies (ranging from 0.785 to 0.789). Risk of Malignancy Index + human epididymis protein 4 was the most cost-effective in all sensitivity and scenario analyses.
CONCLUSIONS: Risk of Malignancy Index + human epididymis protein 4 is a cost-effective strategy in the referral decision-making process of a general hospital for patients with an ovarian mass, compared to Risk of Malignancy Index alone or no strategy.