{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T18:07:48Z","timestamp":1791655668687,"version":"4.3.4"},"reference-count":44,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the costs and consequences of seven diagnostic strategies for ovarian cancer in pre\u2010 and post\u2010menopausal women with symptoms in secondary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Economic evaluation alongside a prospective single\u2010arm diagnostic accuracy study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>NHS secondary care outpatients (2\u2010week referrals, clinics, GP referrals, cross\u2010specialty referrals) and inpatients (emergency presentations to secondary care).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Sample<\/jats:title>\n                    <jats:p>Two cohorts of 857 pre\u2010menopausal and 1242 post\u2010menopausal women newly presenting to secondary care with symptoms of suspected ovarian cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A model\u2010based cost\u2010consequence analysis (CCA) was conducted using a decision tree simulating patient pathways over 12 months. Diagnostic accuracy data were sourced from the ROCkeTS study and supplemented by literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Cancer deaths, correct diagnosis proportion, and diagnostic yield.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>No diagnostic strategy was optimal across all outcomes. Across both cohorts, the Risk of Malignancy Index (RMI) 200 was least expensive but had poor cancer death and diagnostic yield outcomes. The ADNEX 3% strategy had the highest diagnostic yield and lowest cancer mortality but was the most expensive. For pre\u2010menopausal women, the IOTA ADNEX 10% strategy outperformed ORADS, ROMA, and CA125 in cost and outcomes. For post\u2010menopausal women, the high cancer prevalence required a trade\u2010off. In sensitivity analysis, a two\u2010step IOTA ADNEX 10% strategy outperformed ORADS, ROMA, and CA125 across all three outcomes, making the strategy a more balanced choice in both cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>At 12\u2009months, no single diagnostic strategy was superior. Early diagnosis requires balancing cancer mortality, diagnostic yield, and cost. The IOTA ADNEX two\u2010step strategy at a 10% threshold provided the best trade\u2010off across these factors and is recommended for practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.70074","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T07:39:08Z","timestamp":1762414748000},"page":"680-689","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A Cost Consequence Analysis of Seven Diagnostic Strategies for Ovarian Cancer: A Model\u2010Based Economic Evaluation"],"prefix":"10.1111","volume":"133","author":[{"given":"Samuel J.","family":"Perry","sequence":"first","affiliation":[{"name":"Department of Applied Health Sciences, College of Medicine and Health University of Birmingham  Birmingham 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Lien","family":"Kwong","sequence":"additional","affiliation":[{"name":"Department of Cancer and Genomic Sciences University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Williams","sequence":"additional","affiliation":[{"name":"University Hospitals Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Deeks","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences, College of Medicine and Health University of Birmingham  Birmingham UK"},{"name":"NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Scandrett","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences, College of Medicine and Health University of Birmingham  Birmingham UK"},{"name":"NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ridhi","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences, College of Medicine and Health University of Birmingham  Birmingham UK"},{"name":"NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5843-3015","authenticated-orcid":false,"given":"Sudha S.","family":"Sundar","sequence":"additional","affiliation":[{"name":"Department of Cancer and Genomic Sciences University of Birmingham  Birmingham UK"},{"name":"Pan Birmingham Gynaecological Cancer Centre Midlands Metropolitan University Hospital  Birmingham 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