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.

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.