Table 4.
Discounted Costs, Life Years, QALYs, and Incremental Cost-Effectiveness Ratios of Risk-Reducing Interventions for Women at Increased or High Risk for Endometrial Cancer.
| Study, Country, Currency | Target Population Compared Strategies |
Over no Intervention or Current Practice | Compared to Next Non-Dominated | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Incr. Costs in 2019 Euro (in 2019 USD) |
Incr. LY | Incr. QALY | ICER in 2019 EUR/LYG (in 2019 USD/LYG) |
ICUR in 2019 EUR/QALY (in 2019 USD/ QALY) |
Incr. Costs in 2019 Euro a (in 2019 USD) |
Incr. LYG a | Incr. QALY a | ICER in 2019 EUR/ LYG a (in 2019 USD/LYG) |
ICUR in 2019 EUR/ QALY a (in 2019 USD/QALY) |
||
| Kwon et al., 2008, USA, USD [19] |
Target population: women with Lynch syndrome, age 30 yrs and older, 40–60% lifetime risk for endometrial cancer, 42% for colon cancer (colon and endometrial cancer) | ||||||||||
| Strategies: | |||||||||||
| No intervention | - | - | - | - | - | - | - | - | - | - | |
| PBSO + hysterectomy at 30 yrs | 5555 (6218) |
1.996 | 0.353 | 2783 (3115) |
15,724 (17,600) |
5555 (6218) |
1.996 | 0.353 | 2783 (3115) |
Ext dom | |
| PBSO + hysterectomy at 40 yrs | 6304 (7056) |
1.053 | 0.485 | 5984 (6699) |
13,003 (14,555) |
749 (838) |
Dom | 0.132 | Dom | 5695 (6375) |
|
| EB, TVS, CA-125, age 30–39, 1 yr; PBSO + hysterectomy, age 40 | 13,716 (15,353) |
1.118 | 0.518 | 12,272 (13,736) |
26,459 (29,616) |
7412 (8297) |
Dom | 0.034 | Dom | 220,599 (246,920) |
|
| EB, TVS, CA-125, age 30+, 1 yr | 19,592 (21,930) |
0.45 | 0.20 | 43,586 (48,787) |
95,804 (107,235) |
Dom | Dom | Dom | Dom | Dom | |
| Yang et al., 2011, USA, USD [20] |
Target population: high-risk: Lynch syndrome, women age 30 yrs, 40–60% lifetime risk of endometrial cancer (colon and endometrial cancer) | ||||||||||
| Strategies: | |||||||||||
| PBSO+hysterectomy, at 30 yrs | n.r. | n.r. | n.r. | n.r. | n.r. | n.r. | n.r. | n.r. | - | - | |
| Exam, TVS, CA- 125, EB, age 30+, 1 yr | n.r. | n.r. | n.r. | n.r. | n.r. | Dom | n.r. | Dom | n.r. | Dom | |
| Exam, TVS, age 30+, 1 yr | n.r. | n.r. | n.r. | n.r. | n.r. | Dom | n.r. | Dom | n.r. | Dom | |
| Havrilesky et al., 2017, USA, USD [21] |
Target population: BRCA-1 mutation carriers, women age 40 yrs with no cancer (following PBM+PBSO), 3.5% lifetime risk for endometrial cancer | ||||||||||
| Strategies: | |||||||||||
| PBM + PBSO + hysterectomy, at 40 yrs | n.r. | n.r. | n.r. | n.r. | n.r. | n.r. | n.r. | n.r. | - | - | |
| PBM+PBSO, at 40 yrs | n.r. | n.r. | n.r. | n.r. | n.r. | Dom | Dom | n.r. | Dom | 12,989 (14,539) |
|
| Dottino, 2016, USA USD [16] |
Target population: obese women, age 50 yrs, from 4% to 7% (age dependent) lifetime risk for endometrial cancer | ||||||||||
| Strategies: | |||||||||||
| No intervention | - | - | - | - | - | - | - | - | - | - | |
| Levonorgestrel, age 50–55 | n.r. | n.r. | n.r. | 71,992 (80,582) |
n.r. | n.r. | n.r. | n.r. | 71,992 (80,582) |
n.r. | |
| Kwon and Lu, 2008, USA, USD [18] |
Target population: obese (> BMI 30 kg/m²) women, age 30–80 yrs, 3% lifetime risk for endometrial cancer | ||||||||||
| Strategies: | |||||||||||
| No intervention | - | - | - | - | - | - | - | - | - | - | |
| OCP, age 30–35 | 2982 (3338) |
0.0065 | n.r. | 458,780 (513,521) |
n.r. | 2982 (3338) |
0.0065 | n.r. | 458,780 (513,521) |
n.r. | |
| Exam, EB, age 30–80, 2 yrs | 18,409 (20,606) |
0.0100 | n.r. | 1,840,907 (2,060,562) |
n.r. | Ext dom | Ext dom | n.r. | Ext dom | n.r. | |
| Exam, EB, age 30–80,1 yr | 29,551 (33,077) |
0.0172 | n.r. | 1,718,084 (1,923,084) |
n.r. | 26,569 (29,739) |
0.0107 | n.r. | 2,483,081 (2,779,361) |
n.r. | |
Dom: dominated, EB: endometrial biopsy, Ext dom: extended dominance, ICER: incremental cost-effectiveness ratio, ICUR: incremental cost-utility ratio, LYG: life years gained, OCP: oral contraceptive pills, PBM: prophylactic mastectomy, PBSO: prophylactic bilateral salpingo-oophorectomy, QALY: quality-adjusted life year, TVS: transvaginal sonography, yrs: years. a calculated versus next (non-dominated) strategy.