{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:35:46Z","timestamp":1791999346917,"version":"4.4.0"},"reference-count":158,"publisher":"National Institute for Health and Care Research","issue":"44","license":[{"start":{"date-parts":[[2018,8,1]],"date-time":"2018-08-01T00:00:00Z","timestamp":1533081600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["16\/30\/02"],"award-info":[{"award-number":["16\/30\/02"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"<jats:sec id=\"abs1-1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ovarian cancer is the sixth most common cancer in UK women and can be difficult to diagnose, particularly in the early stages. Risk-scoring can help to guide referral to specialist centres.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-2\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the clinical and cost-effectiveness of risk scores to guide referral decisions for women with suspected ovarian cancer in secondary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-3\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty-one databases, including MEDLINE and EMBASE, were searched from inception to November 2016. Review methods followed published guidelines. The meta-analysis using weighted averages and random-effects modelling was used to estimate summary sensitivity and specificity with 95% confidence intervals (CIs). The cost-effectiveness analysis considered the long-term costs and quality-adjusted life-years (QALYs) associated with different risk-scoring methods, and subsequent care pathways. Modelling comprised a decision tree and a Markov model. The decision tree was used to model short-term outcomes and the Markov model was used to estimate the long-term costs and QALYs associated with treatment and progression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fifty-one diagnostic cohort studies were included in the systematic review. The Risk of Ovarian Malignancy Algorithm (ROMA) score did not offer any advantage over the Risk of Malignancy Index 1 (RMI 1). Patients with borderline tumours or non-ovarian primaries appeared to account for disproportionately high numbers of false-negative, low-risk ROMA scores. (Confidential information has been removed.) To achieve similar levels of sensitivity to the Assessment of Different NEoplasias in the adneXa (ADNEX) model and the International Ovarian Tumour Analysis (IOTA) group\u2019s simple ultrasound rules, a very low RMI 1 decision threshold (25) would be needed; the summary sensitivity and specificity estimates for the RMI 1 at this threshold were 94.9% (95% CI 91.5% to 97.2%) and 51.1% (95% CI 47.0% to 55.2%), respectively. In the base-case analysis, RMI 1 (threshold of 250) was the least effective [16.926 life-years (LYs), 13.820 QALYs] and the second cheapest (\u00a35669). The IOTA group\u2019s simple ultrasound rules (inconclusive, assumed to be malignant) were the cheapest (\u00a35667) and the second most effective [16.954 LYs, 13.841 QALYs], dominating RMI 1. The ADNEX model (threshold of 10%), costing \u00a35699, was the most effective (16.957 LYs, 13.843 QALYs), and compared with the IOTA group\u2019s simple ultrasound rules, resulted in an incremental cost-effectiveness ratio of \u00a315,304 per QALY gained. At thresholds of up to \u00a315,304 per QALY gained, the IOTA group\u2019s simple ultrasound rules are cost-effective; the ADNEX model (threshold of 10%) is cost-effective for higher thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-5\">\n                    <jats:title>Limitations<\/jats:title>\n                    <jats:p>Information on the downstream clinical consequences of risk-scoring was limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-6\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Both the ADNEX model and the IOTA group\u2019s simple ultrasound rules may offer increased sensitivity relative to current practice (RMI 1); that is, more women with malignant tumours would be referred to a specialist multidisciplinary team, although more women with benign tumours would also be referred. The cost-effectiveness model supports prioritisation of sensitivity over specificity. Further research is needed on the clinical consequences of risk-scoring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-7\">\n                    <jats:title>Study registration<\/jats:title>\n                    <jats:p>This study is registered as PROSPERO CRD42016053326.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-8\">\n                    <jats:title>Funding details<\/jats:title>\n                    <jats:p>The National Institute for Health Research Health Technology Assessment programme.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3310\/hta22440","type":"journal-article","created":{"date-parts":[[2018,8,31]],"date-time":"2018-08-31T04:53:38Z","timestamp":1535691218000},"page":"1-264","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":152,"title":["Risk scores to guide referral decisions for people with suspected ovarian cancer in secondary care: a systematic review and cost-effectiveness analysis"],"prefix":"10.3310","volume":"22","author":[{"given":"Marie","family":"Westwood","sequence":"first","affiliation":[{"name":"Kleijnen Systematic Reviews Ltd, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bram","family":"Ramaekers","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre and CAPHRI, School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shona","family":"Lang","sequence":"additional","affiliation":[{"name":"Kleijnen Systematic Reviews Ltd, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Grimm","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre and CAPHRI, School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohan","family":"Deshpande","sequence":"additional","affiliation":[{"name":"Kleijnen Systematic Reviews Ltd, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelley","family":"de Kock","sequence":"additional","affiliation":[{"name":"Kleijnen Systematic Reviews Ltd, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Kleijnen Systematic Reviews Ltd, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"Joore","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre and CAPHRI, School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos","family":"Kleijnen","sequence":"additional","affiliation":[{"name":"School for Public Health and Primary Care, Care and Public Health Research Institute (CAPHRI), Maastricht University, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6221","published-online":{"date-parts":[[2018,8]]},"reference":[{"key":"key20180830111133085_ref1-bib1","volume-title":"Ovarian Cancer: The Recognition and Initial Management of Ovarian Cancer","author":"National Collaborating Centre for Cancer","year":"2011"},{"key":"key20180830111133085_ref1-bib2","first-page":"1","article-title":"Management of adnexal mass","volume":"130","author":"Myers","year":"2006","journal-title":"Evid Rep Technol Assess"},{"key":"key20180830111133085_ref1-bib3","doi-asserted-by":"publisher","first-page":"87","DOI":"10.3802\/jgo.2015.26.2.87","article-title":"FIGO\u2019s staging classification for cancer of the ovary, fallopian tube, and peritoneum: abridged republication","volume":"26","author":"Prat","year":"2015","journal-title":"J Gynecol Oncol"},{"key":"key20180830111133085_ref1-bib4","volume-title":"Cancer Registration Statistics, England: 2014. 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