Evaluation of the cost of CA-125 measurement, physical exam, and imaging in the diagnosis of recurrent ovarian cancer.
OBJECTIVE
Ovarian cancer accounts for 50% of deaths from gynecologic malignancies. We sought to determine the cost of common methods of surveillance of women with ovarian cancer in first clinical remission. The current standard for post treatment surveillance is the National Comprehensive Cancer Network (NCCN) guidelines.


METHODS
We retrospectively determined how recurrence was initially detected at our institution and a cost model was created and applied to the United States population to calculate surveillance costs using the Surveillance Epidemiology & End Results (SEER) database.


RESULTS
57% (n=60) of first recurrences were identified by increasing CA 125 level. Routine office visit identified 27% (n=29) of recurrences, and 15% (n=16) were diagnosed initially with CT scan. In 5% (5/105), CT abnormality was the only finding. 95% (100/105) of patients had either elevated CA 125 or office visit findings at time of recurrence. Of the 22,000 women diagnosed with ovarian cancer yearly, 60% (n=13,266) will have advanced disease and are likely to recur. The surveillance cost for this population for 2 years using our model is $32,500,000 using NCCN guidelines and $58,000,000 if one CT scan is obtained.


CONCLUSIONS
Our data suggests that following NCCN guidelines will detect 95% of recurrences. An additional $26 million will be needed to identify the 5% of women with recurrence seen on CT only. Post treatment surveillance of ovarian cancer patients contributes significantly to health care costs. Use of CT scan to follow these patients largely increases cost with only a small increase in recurrence detection.
University Hospital Case Medical Center, 11100 Euclid Ave., Cleveland, OH 44106, USA. Electronic address: amy.armstrong@uhhospitals.org.
Amy
A
Armstrong
Balint
B
Otvos
Sareena
S
Singh
Robert
R
Debernardo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018394:CA-125 Antigen / Q000032:analysis*; D003362:Cost-Benefit Analysis; D003952:Diagnostic Imaging / Q000191:economics / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008565:Membrane Proteins / Q000032:analysis*; D008875:Middle Aged; D018803:Models, Economic; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000191:economics*; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000191:economics*; D010808:Physical Examination / Q000191:economics / Q000379:methods; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018426:SEER Program; D014481:United States
D018394:CA-125 Antigen; C451759:MUC16 protein, human; D008565:Membrane Proteins
Cost; Ovarian cancer; Surveillance