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

Wu, R.
; 
Arendse, K. D.
; 
Hamdani, T.
; 
Walter, F. M.
; 
Crosbie, E. J.
; 
Mihaylova, B.
; 
Funston, G.
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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.
Authors
Wu, R.
Arendse, K. D.
Hamdani, T.
Walter, F. M.
Crosbie, E. J.
Mihaylova, B.
Funston, G.
Affiliation
Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK. r.wu@qmul.ac.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. Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK. Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. Gynaecological Oncology Research Group, Division of Cancer Sciences, University of Manchester, Manchester, UK. Manchester Academic Health Sciences Centre, Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester, UK. Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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2025
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All Paterson Institute for Cancer Research
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Wu R, Arendse KD, Hamdani T, Walter FM, Crosbie EJ, Mihaylova B, et al. Cost-effectiveness of CA125- and age-informed risk-based triage for ovarian cancer detection in primary care. British journal of cancer. 2025 Sep 17. PubMed PMID: 40962845. Pubmed Central PMCID: PMC7618296. Epub 2025/09/18. eng.
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https://christie.openrepository.com/handle/10541/627627
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