Over ovarian cancer presenting too late?

There’s a screening algorithm for that. The UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) published last year in Lancet successfully randomized >200K women (US, take notes) to three forms of screening: routine ultrasound (US), a multimodal approach using CA-125 with reflex US based on risk of ovarian cancer proprietary algorithm (ROCA) results, or standard no screening. At most recent reporting, there was a significant 20% reduction in mortality when comparing multimodal screening to nothing. Ok, so it’s effective. But is it cost effective? A new pub out in JAMA Onc last week gives that question a hard maybe. Unlike last month’s unicorn of cost-effectiveness analyses, this study (predictably) reports that multimodal screening was both more effective and more expensive. The authors calculate that, in 70% of all simulated possible realities, the cost of attaining one quality-adjusted life year (QALY) via multimodal screening for women >50 years would fall below the magical $150K threshold. The real (ok, simulated) truth is that more UKCTOCS follow-up time is needed to seal the deal for ovarian cancer screening.