The utility and cost of routine follow-up procedures in the surveillance of ovarian and primary peritoneal carcinoma: a 16-year institutional review.
BACKGROUND
The purpose of this study was to evaluate the number of ovarian cancer and primary peritoneal cancer (PPC) progressive disease cases identified via routine follow-up procedures and the corresponding cost throughout a 16-year period at a single medical institution.


METHODS
Previously undiagnosed epithelial ovarian (n=241), PPC (n=23), and concurrent ovarian and uterine (n=24) cancer patients were treated and then followed via CA-125, imaging (e.g., CT scan, chest X-ray), physical examination and vaginal cytology.


RESULTS
In the group of 287 patients, there were 151 cases of disease progression. Serial imaging detected the highest number of progressive disease cases (66 initial and 45 confirmatory diagnoses), but the cost was rather high ($13,454 per patient recurrence), whereas CA-125 testing (74 initial and 20 corroborative diagnoses) was the least expensive ($3,924) per recurrent diagnosis. The total cost of surveillance during the 16-year period was nearly $2,400,000.


CONCLUSIONS
Ultimately, serial imaging and the CA-125 assay detected the highest number of ovarian cancer and PCC progressive disease cases in comparison to physical examination and vaginal cytology, but nevertheless, all of the procedures were conducted at a considerable financial expense.
Department of Molecular, Cell and Developmental Biology, UCLA College of Letters and Science, Los Angeles, CA, USA.
N B
NB
Rettenmaier
C R
CR
Rettenmaier
T
T
Wojciechowski
L N
LN
Abaid
J V
JV
Brown
J P
JP
Micha
B H
BH
Goldstein
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018394:CA-125 Antigen / Q000097:blood; D003365:Costs and Cost Analysis; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D010051:Ovarian Neoplasms / Q000175:diagnosis*; D010534:Peritoneal Neoplasms / Q000175:diagnosis*; D010808:Physical Examination / Q000191:economics; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed; D014626:Vaginal Smears / Q000191:economics
D018394:CA-125 Antigen