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Comparative Study
. 2018 Feb;148(2):329-335.
doi: 10.1016/j.ygyno.2017.12.015. Epub 2017 Dec 19.

Cost effectiveness of neoadjuvant chemotherapy followed by interval cytoreductive surgery versus primary cytoreductive surgery for patients with advanced stage ovarian cancer during the initial treatment phase

Arthur-Quan Tran  1 , Daniel O Erim  2 , Stephanie A Sullivan  3 , Ashley L Cole  4 , Emma L Barber  3 , Kenneth H Kim  5 , Paola A Gehrig  3 , Stephanie B Wheeler  2
Affiliations
Comparative Study

Cost effectiveness of neoadjuvant chemotherapy followed by interval cytoreductive surgery versus primary cytoreductive surgery for patients with advanced stage ovarian cancer during the initial treatment phase

Arthur-Quan Tran et al. Gynecol Oncol. 2018 Feb.

Abstract

Objective: Advanced stage epithelial ovarian cancer (AEOC) can be treated with either neoadjuvant chemotherapy (NACT) or primary cytoreductive surgery (PCS). Although randomized controlled trials show that NACT is non-inferior in overall survival compared to PCS, there may be improvement in short-term morbidity. We sought to investigate the cost-effectiveness of NACT relative to PCS for AEOC from the US Medicare perspective.

Methods: A cost-effectiveness analysis using a Markov model with a 7-month time horizon comparing (1) 3cycles of NACT with carboplatin and paclitaxel (CT), followed by interval cytoreductive surgery, then 3 additional cycles of CT, or (2) PCS followed by 6cycles of CT. Input parameters included probability of chemotherapy complications, surgical complications, treatment completion, treatment costs, and utilities. Model outcomes included costs, life-years gained, quality-adjusted life-years (QALYs) gained, and incremental cost-effectiveness ratios (ICER), in terms of cost per life-year gained and cost per QALY gained. We accounted for differences in surgical complexity by incorporating the cost of additional procedures and the probability of undergoing those procedures. Probabilistic sensitivity analysis (PSA) was performed via Monte Carlo simulations.

Results: NACT resulted in a savings of $7034 per patient with a 0.035 QALY increase compared to PCS; therefore, NACT dominated PCS in the base case analysis. With PSA, NACT was the dominant strategy more than 99% of the time.

Conclusions: In the short-term, NACT is a cost-effective alternative compared to PCS in women with AEOC. These results may translate to longer term cost-effectiveness; however, data from randomized control trials continues to mature.

Keywords: Cost-effective analysis; Neoadjuvant chemotherapy; Ovarian cancer; Primary cytoreduction.

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Conflict of interest statement

DISCLOSURE STATEMENT: The authors report no conflict of interest.

Figures

Figure 1
Figure 1
Markov model of patients undergoing neoadjuvant chemotherapy compared to primary cytoreductive surgery. Abbreviations: AEOC: advanced stage epithelial ovarian cancer, NACT: neoadjuvant chemotherapy, PCS: primary cytoreductive surgery, CT: chemotherapy, AE: adverse event
Figure 2
Figure 2
Cost-effectiveness scatter plot. Comparison between primary cytoreductive surgery and neoadjuvant chemotherapy for treating women with advanced stage epithelial ovarian carcinoma.
See this image and copyright information in PMC

References

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