Cost Effective Management of Pelvic Masses How ROMA Outperforms Traditional Clinical Risk Assessment

Introduction

The management of pelvic masses poses a major challenge in gynecologic oncology, where accurate risk assessment is critical for timely intervention and optimal patient outcomes. The integration of the Risk of Ovarian Malignancy Algorithm (ROMA) into clinical pathways is transforming how pelvic masses are assessed, significantly impacting healthcare costs and surgical decision-making.
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Evaluating Cost-Effective Approaches in Pelvic Mass Management

Recent research published in the Clinical Journal of Obstetrics and Gynecology highlights a cost-analysis comparison between traditional Initial Clinical Risk Assessment (ICRA) and the more advanced ROMA score in managing women with pelvic masses (Read full study).

Key Findings:

• ROMA alone reduced healthcare costs by 3.3% compared to ICRA alone.
• Combination of ROMA + ICRA reduced costs by 3.9%, making it even more cost-effective.
• ROMA reduced the number of repeat surgeries by 63%, a major advantage in minimizing patient risks and overall expenses.

The Power of ROMA in Clinical Decision Making

The ROMA score, which combines serum CA125, HE4 biomarkers, and menopausal status, demonstrates:

• Higher sensitivity (94%) in detecting epithelial ovarian cancer.
• A Negative Predictive Value (NPV) of 99%, ensuring more accurate differentiation between benign and malignant pelvic masses.
• A significant reduction in unnecessary surgeries when used as the primary assessment tool.

According to the American College of Obstetricians and Gynecologists (ACOG), early referral to gynecologic oncologists based on accurate risk stratification is crucial in improving patient survival rates.

Financial Implications and Healthcare Savings

Cost Comparison Highlights:

• ROMA testing led to a 55% increase in laboratory costs but significantly reduced expensive surgical procedures.
• Laparoscopy costs were reduced by 4%, while laparotomy costs saw a 3.1% reduction.
• Incorporating ROMA could lead to a 4.2%–5.6% decrease in overall healthcare expenditures in cases involving all cancer diagnoses.

Breakdown of Average Cost Reductions:

• Laparoscopy: Savings of up to $142,523
• Laparotomy: Savings of up to $25,151
• Overall surgery: Savings of up to $167,674

A detailed analysis can be found in our main journal article journal.cjog.1001112.

Referral to Specialists

Using ROMA effectively changed referral pathways:

• 64% increase in initial surgeries performed by gynecologic oncologists.
• 17%-18% decrease in initial surgeries performed by general gynecologists.
• Significant reduction in repeat surgeries, preventing unnecessary procedures and enhancing patient care quality.

The Broader Impact on Cancer Care Costs

With cancer care costs predicted to rise to $246 billion by 2030 (source: National Cancer Institute), strategies like implementing ROMA not only improve patient outcomes but also contribute significantly to cost containment within healthcare systems.

Conclusion

The study underscores that using ROMA, either alone or alongside ICRA, leads to better patient triage, fewer repeat surgeries, and overall cost savings in the management of women with pelvic masses. As healthcare systems grapple with rising costs, integrating sensitive, reliable diagnostic tools like ROMA offers a pathway to both clinical excellence and economic sustainability.

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