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Clinical Trial
. 2024 Nov;35(6):e117.
doi: 10.3802/jgo.2024.35.e117. Epub 2024 Oct 18.

Cost-effectiveness analysis of simple hysterectomy compared to radical hysterectomy for early cervical cancer: analysis from the GCIG/CCTG CX.5/SHAPE trial

Janice S Kwon  1 , Helen McTaggart-Cowan  2 , Sarah E Ferguson  3 , Vanessa Samouëlian  4 , Eric Lambaudie  5 , Frédéric Guyon  6 , John Tidy  7 , Karin Williamson  8 , Noreen Gleeson  9 , Cor de Kroon  10 , Willemien van Driel  11 , Sven Mahner  12 , Lars Hanker  13 , Frédéric Goffin  14 , Regina Berger  15 , Brynhildur Eyjólfsdóttir  16 , Jae-Weon Kim  17 , Lori A Brotto  18 , Reka Pataky  2 , Shirley S T Yeung  2 , Kelvin K W Chan  19 , Matthew C Cheung  19 , Juliana Ubi  20 , Dongsheng Tu  20 , Lois E Shepherd  20 , Marie Plante  21
Affiliations
Clinical Trial

Cost-effectiveness analysis of simple hysterectomy compared to radical hysterectomy for early cervical cancer: analysis from the GCIG/CCTG CX.5/SHAPE trial

Janice S Kwon et al. J Gynecol Oncol. 2024 Nov.

Abstract

Objective: SHAPE (Simple Hysterectomy And PElvic node assessment) was an international phase III trial demonstrating that simple hysterectomy was non-inferior to radical hysterectomy for pelvic recurrence risk, but superior for quality of life and sexual health. The objective was to conduct a cost-effectiveness analysis comparing simple vs. radical hysterectomy for low-risk early-stage cervical cancer.

Methods: Markov model compared the costs and benefits of simple vs. radical hysterectomy for early cervical cancer over a 5-year time horizon. Quality-adjusted life years (QALYs) were estimated from health utilities derived from EQ-5D-3L surveys. Sensitivity analyses accounted for uncertainty around key parameters. Monte Carlo simulation estimated complication numbers according to surgical procedure.

Results: Simple hysterectomy was more effective and less costly than radical hysterectomy. Average overall costs were $11,022 and $12,533, and average gains were 3.56 and 3.54 QALYs for simple and radical hysterectomy, respectively. Baseline health utility scores were 0.81 and 0.83 for simple and radical hysterectomy, respectively. By year 3, these scores improved for simple hysterectomy (0.82) but not for radical hysterectomy (0.82). Assuming 800 early cervical cancer patients annually in Canada, the model estimated 3 vs. 82 patients with urinary retention, and 49 vs. 86 patients with urinary incontinence persisting 4 weeks after simple vs. radical hysterectomy, respectively. Results were most sensitive to variability in health utilities after surgery, but stable through wide ranges of costs and recurrence estimates.

Conclusion: Simple hysterectomy is less costly and more effective in terms of quality-adjusted life expectancy compared to radical hysterectomy for early cervical cancer.

Trial registration: ClinicalTrials.gov Identifier: NCT01658930.

Keywords: Cost-Effectiveness; Early Stage Cervical Cancer; Health Utility; Low Risk; Quality-Adjusted Life Expectancy; Radical Hysterectomy; Simple Hysterectomy.

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Conflict of interest statement

JSK discloses research funding from Michael Smith Health Research BC (formerly Michael Smith Foundation for Health Research), ownership of shares from Hexamer Therapeutics, and speaker fee from Astra Zeneca. MP discloses research funding from Astra Zeneca, royalties from UpToDate, and serving as an Advisory Board member for Serono-Merck.

Figures

Fig. 1
Fig. 1. Two-way sensitivity analysis on RFS.
RFS, recurrence-free survival.
Fig. 2
Fig. 2. Cost-effectiveness scatterplot.
Fig. 3
Fig. 3. Tornado diagram.
RFS, recurrence-free survival.
See this image and copyright information in PMC

References

    1. National Library of Medicine. Radical versus simple hysterectomy and pelvic node dissection with low-risk early stage cervical cancer (SHAPE) [Internet] Bethesda, MD: National Library of Medicine; 2024. [cited 2024 Mar 5]. Available from: https://clinicaltrials.gov/study/NCT01658930.
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