J Gynecol Oncol.  2014 Apr;25(2):97-104. 10.3802/jgo.2014.25.2.97.

Cost-utility analysis of treatments for stage IB cervical cancer

• Katanyoo K
• Praditsitthikorn N
• Tangjitgamol S
• Manusirivithaya S
• Supawattanabodee B

• KMID: 1708331
• DOI: http://doi.org/10.3802/jgo.2014.25.2.97

Abstract

OBJECTIVE
To analyze the cost-utility of two common clinical practices for stage IB cervical cancer patients from provider and societal viewpoints.
METHODS
A decision tree model was conducted to examine value for expenditure between the following: (1) radical hysterectomy with pelvic lymph node dissection (RHPLND) with or without postoperative adjuvant therapy according to the risk of recurrence and (2) concurrent chemoradiotherapy (CCRT). The relevant studies were identified to extract the probability data, and meta-analysis was performed. Direct medical costs were estimated from hospital database and medical records review. Direct non-medical costs and utility parameters were obtained through interviews with patients to estimate quality-adjusted life years (QALYs) outcome. The time horizon was according to the life expectancy of Thai women.
RESULTS
From provider viewpoint, RHPLND and CCRT resulted in approximate costs of US $5,281 and US $5,218, respectively. The corresponding costs from societal viewpoint were US $6,533 and US $6,335, respectively. QALYs were 16.40 years for RHPLND and 15.94 years for CCRT. The estimated incremental cost effectiveness ratio of RHPLND in comparison to CCRT from provider and societal viewpoints were US $100/QALY and US $430/QALY, respectively. RHPLND had more cost-effectiveness than CCRT if patients did not need adjuvant therapy. The most effective parameter in model was a direct medical cost of CCRT. At the current ceiling ratio in Thailand, RHPLND provides better value for money than CCRT, with a probability of 75%.
CONCLUSION
RHPLND is an efficient treatment for stage IB cervical cancer. This advantage is only for patients who require no adjuvant treatment.

Keyword

Cervical cancer; Concurrent chemoradiotherapy; Cost-utility analysis; Radical hysterectomy; Stage IB

MeSH Terms

Asian Continental Ancestry Group
Chemoradiotherapy
Cost-Benefit Analysis
Decision Trees
Female
Health Expenditures
Humans
Hysterectomy
Life Expectancy
Lymph Node Excision
Medical Records
Quality-Adjusted Life Years
Recurrence
Thailand
Uterine Cervical Neoplasms*

Figure

• 

  Fig. 1 Decision tree model: two branches (radical hysterectomy with pelvic lymph node dissection [RHPLND] and concurrent chemoradiotherapy [CCRT]) from decision node. Aborted-CCRT, aborted RHPLND and received concurrent chemoradiotherapy; Sx_no disease, salvage treatment by surgery and no disease; I/C, indication; IR_RT, intermediate risk and received postoperative radiation therapy; HR_CCRT, high risk and received postoperative concurrent chemoradiotherapy; CCRT_no disease, salvage treatment by concurrent chemoradiotherapy and no disease; "no disease" means that there is no evidence of disease recurrence for a lifetime; "disease" means that there are evidence of disease recurrence including local recurrence or distant metastasis, which can or cannot receive salvage treatment for cure again; "disease_palliation" means that there is evidence of disease recurrence including local recurrence or distant metastasis, which cannot receive salvage treatment again. Therefore, the further treatment is palliation.

• 

  Fig. 2 Cost-effectiveness acceptability curve at willingness-to-pay (US $3,750 or 120,000 Thai Baht). CCRT, concurrent chemoradiotherapy; RHPLND, radical hysterectomy with pelvic lymph node dissection.

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