基于CA125和年龄信息的风险分层分诊在初级保健中检测卵巢癌的成本效益

Cost-effectiveness of CA125- and age-informed risk-based triage for ovarian cancer detection in primary care.

作者信息

Wu Runguo, Arendse Kirsten D, Hamdani Tooba, Walter Fiona M, Crosbie Emma J, Mihaylova Borislava, Funston Garth

机构信息

Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK.

Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK.

出版信息

Br J Cancer. 2025 Sep 17. doi: 10.1038/s41416-025-03166-3.

DOI:10.1038/s41416-025-03166-3

PMID:40962845

Abstract

BACKGROUND

In England, current practice is cancer antigen 125 (CA125) testing with pelvic ultrasound scan (USS) if CA125 is ≥35 U/mL for triage of women with suspected ovarian cancer (OC) in primary care. However, OC risk varies with CA125 level and age. The Ovatools model predicts OC risk based on age and CA125 levels to support primary care triage.

METHODS

We evaluated five alternative triage pathways for suspected OC in primary care, using a decision model. Two CA125-USS sequential pathways used Ovatools risk: 1-3% (subsequent USS) and ≥3% (urgent referral), or age-adjusted CA125 thresholds equivalent to Ovatools risks. Three pathways involved concurrent CA125-USS testing, with referral if abnormal USS or one of the following: (1) Ovatools risk ≥3%, (2) CA125 above the equivalent age-adjusted threshold, or (3) CA125 ≥ 35 U/mL. Clinical and cost-effectiveness was compared against current practice for women over and under 50 years.

RESULTS

All alternative pathways increased benefits at age ≥50 years, at additional cost. The incremental cost-effectiveness ratios for CA125-USS sequential pathways were below £30,000, dropping below £20,000 if the Ovatools threshold for USS increased to 1.2-1.4% risk.

DISCUSSION

For women ≥50 years, the Ovatools and equivalent age-adjusted threshold sequential pathways are cost-effective compared to current practice.

摘要

背景

在英国，目前的做法是，对于基层医疗中疑似卵巢癌（OC）的女性进行分流时，如果癌抗原125（CA125）≥35 U/mL，则进行盆腔超声扫描（USS）检查。然而，OC风险随CA125水平和年龄而变化。Ovatools模型基于年龄和CA125水平预测OC风险，以支持基层医疗分流。

方法

我们使用决策模型评估了基层医疗中疑似OC的五种替代分流途径。两种CA125-USS序贯途径使用Ovatools风险：1-3%（随后进行USS）和≥3%（紧急转诊），或与Ovatools风险相当的年龄调整后的CA125阈值。三种途径涉及同时进行CA125-USS检测，如果USS异常或出现以下情况之一则进行转诊：（1）Ovatools风险≥3%，（2）CA125高于等效的年龄调整阈值，或（3）CA125≥35 U/mL。将50岁及以上和50岁以下女性的临床和成本效益与当前做法进行了比较。