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Multicenter Study
. 2020 Dec;64(6):873-881.
doi: 10.1111/1754-9485.13103. Epub 2020 Sep 26.

Cost-utility analysis of adjuvant chemotherapy after concurrent chemoradiation in patients with locally advanced cervical cancer

Kanisa Rongsriyam  1 , Siriwan Tangjitgamol  2 , Pattara Leelahavarong  3 , Yot Teerawattananon  3 , Ekkasit Tharavichitkul  4 , Chokaew Tovanabutra  5 , Tussawan Asakij  6 , Kannika Paengchit  7 , Jirasak Sukhaboon  8 , Somkit Penpattanagul  9 , Lieutenant Col Apiradee Kridakara  10 , Jitti Hanprasertpong  11 , Jakkapan Khunnarong  2 , Taywin Chottetanaprasith  12 , Vichan Lorvidhaya  4   5
Affiliations
Multicenter Study

Cost-utility analysis of adjuvant chemotherapy after concurrent chemoradiation in patients with locally advanced cervical cancer

Kanisa Rongsriyam et al. J Med Imaging Radiat Oncol. 2020 Dec.

Abstract

Introduction: This study aimed to compare the cost utility of concurrent chemoradiation (CCRT) to CCRT followed by adjuvant chemotherapy (CCRT/ACT) in locally advanced cervical cancer (LACC) using provider and societal viewpoints.

Methods: Data from our trial which was a multi-centre study evaluating the efficacy of ACT compared to CCRT/ACT were entered into a decision tree model. The data included clinical probability, direct medical and non-medical costs, and utility obtained from the patients. The total cost, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICER) were estimated for a time horizon of 3 years. All costs and outcomes were discounted at 3% annually.

Results: The cost of CCRT and CCRT/ACT was approximately 3,058 and 6,896 USD and 4,309 and 7,480 USD from provider and from societal viewpoints, respectively. The QALYs for CCRT and CCRT/ACT were 2.31480 and 2.32045, respectively. The ICER was 569,575 USD per QALY. For stage III-IVA LACC, the ICER was 28,050 USD per QALY. In the sensitivity analysis, the cost of ACT was the most significant influential parameter on the ICER. The ICER would be 0.26-fold lower if the cost of ACT was reduced by 25%. At the current ceiling threshold of 5,000 USD/QALY, CCRT had a 100% probability of being the best option.

Conclusions: In the Thai context, CCRT is more cost effective than CCRT/ACT for stage IIB-IVA LACC. CCRT/ACT may be considered only for stage III-IVA LACC because it has a lower ICER than other types of LACC.

Keywords: adjuvant chemotherapy; concurrent chemoradiation therapy; cost utility; locally advanced cervical cancer.

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References

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