Cost-Effectiveness of Early-Initiated Treatment for Advanced-Stage Epithelial Ovarian Cancer Patients: A Modeling Study

Hoyer, Tom MSc*; Bekkers, Ruud MD, PhD; Gooszen, Hein MD, PhD*; Massuger, Leon MD, PhD; Rovers, Maroeska PhD*‡; Grutters, Janneke P.C. PhD*‡

International Journal of Gynecological Cancer:
doi: 10.1097/IGC.0000000000000025
Ovarian Cancer
Abstract

Objective: Between diagnosis and primary treatment of patients with epithelial ovarian cancer (EOC), gaps of several weeks exist. Reducing these time intervals may benefit the patient and may lead to a reduction of costs. We explored the cost-effectiveness of early-initiated treatment of patients with suspected advanced-stage EOC compared with that of current treatment.

Methods: A discrete event simulation was used to synthesize all available evidences and to evaluate the health care costs and effects (quality-adjusted life years [QALYs]) of the 2 treatment strategies over lifetime. Overall survival, progression-free survival, health-related quality of life, and costs of the separate events were assumed to remain equal. Other uncertainties were addressed using deterministic and probabilistic sensitivity analyses.

Results: The treatment times of current and early-initiated treatment were 27 and 24 weeks, respectively. Early-initiated treatment yielded 3.42 QALYs per patient, for a total expected health care cost of €25,654. Current treatment yielded 3.40 QALYs per patient, for a total expected health care cost of €25,607. This resulted in an incremental cost-effectiveness ratio of €2592 per QALY gained for early-initiated treatment compared with that for current treatment. For the willingness to pay for €30,000 or more per QALY, early-initiated treatment had a 100% probability of being cost-effective compared with current treatment under the previously mentioned assumptions.

Conclusions: Given the current evidence, early-initiated treatment of patients with suspected advanced-stage EOC leads to additional QALYs and seems to be cost-effective compared with current treatment.

Author Information

Departments of *Operating Rooms, †Obstetrics & Gynecology, and ‡Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.

Address correspondence and reprint requests to Janneke P.C. Grutters, PhD, Department of Health Evidence, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500HB Nijmegen, the Netherlands. E-mail: Janneke.grutters@radboudumc.nl.

The authors declare no conflicts of interest.

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Received August 20, 2013

Accepted October 8, 2013

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.