The discounted and undiscounted sur

The discounted and undiscounted survival (life-years), lifetime
costs, and QALYs for each branch in the decision model at the different
OC risk thresholds of 2%, 4%, 5%, 6%, 8% and 10% are given
in Table 3. Discounted results show a smaller overall gain in lifeyears/QALYs
and overall cost difference, as discounting adjusts
costs and outcomes that occur in the future and the cost savings
generated through prevention of future OC cases is valued less. At
the 2% baseline population OC risk level, routine RRSO does not
save more QALYs and is not cost-effective. At a 4% OC risk level,
RRSO saves more QALYs but is not cost-effective at the ICER =
£25,577, which is above the £20,000 NICE threshold. However, at
risk thresholds of ≥5%, RRSO saves more life-years and QALYs and
is highly cost-effective for the NICE threshold of £20,000/QALY.
The ICERs for risk levels of 5%, 6%, 8% and 10% are £15,247, £9958,
£4584, and £1864 respectively. The gains in life expectancy from
RRSO at the risk thresholds of 5%, 6%, 8% and 10% equate to 29.2,
40.1, 62.1 and 80.3 days respectively.
One-way sensitivity analysis results are given in Fig. 2. It suggests
that the results are not that sensitive to treatment costs of RRSO,
OC or cardiovascular events. Results are however sensitive to excess
cardiovascular deaths at the 5% threshold but not that sensitive
at the 6% and 8% thresholds. It is also very sensitive to utilityscores
for RRSO. The model was not cost-effective at the lower
most limit of the utility-score for RRSO. The impact of different variables
on cost-effectiveness decreases as the OC risk threshold
increases