Management of complex pelvic masses using a multivariate index assay: a decision analysis

Area of Science:

• Gynecologic Oncology
• Health Economics
• Medical Decision Making

Background:

• Complex pelvic masses require accurate diagnosis and staging for optimal treatment.
• Current diagnostic methods may lead to suboptimal surgical staging and reoperations.
• Multivariate Index Assay (MIA) is a tool to aid in the diagnosis of ovarian cancer.

Purpose of the Study:

• To conduct a cost-minimization analysis comparing different strategies for managing women with complex pelvic masses.
• To evaluate the cost-effectiveness of using a multivariate index assay (MIA) versus traditional clinical assessment or referral to a gynecologic oncologist (GO).

Main Methods:

• A decision analysis model simulated 81,000 hypothetical patients with complex pelvic masses.
• Three management strategies were compared: CLINICAL assessment, MIA utilization, and referral of all patients to a GO (REFER ALL).
• The analysis considered actual payer costs and various reoperation rates.

Main Results:

• The CLINICAL strategy had the lowest cost ($933.9M) but only 72% appropriate initial staging.
• The MIA strategy ($976.7M) improved staging to 91% but was more expensive.
• The REFER ALL strategy ($939.7M) achieved 100% appropriate staging and was the most cost-effective, especially at higher reoperation rates.

Conclusions:

• While MIA improves initial surgical staging for ovarian cancer, it incurs higher costs.
• Referring all patients with complex pelvic masses to a gynecologic oncologist is the most cost-effective strategy, minimizing reoperations.