Recent research in the International Journal of Gynecological Cancer compared the cost-effectiveness of neoadjuvant chemotherapy versus primary debulking surgery for patients with ovarian cancer.
“Neoadjuvant chemotherapy versus primary debulking surgery for advanced epithelial ovarian cancer remains controversial in the United States,” Ashley L Cole, MPH, of the division of pharmaceutical outcomes and policy at the University of North Carolina’s Eshelman School of Pharmacy, and colleagues wrote. “Generalizability of existing trial results has been criticized because of less aggressive debulking procedures than commonly used in the United States. As a result, economic evaluations using input data from these trials may not accurately reflect costs and outcomes associated with more aggressive primary surgery.”
The researchers used data from a clinical trial of aggressive debulking surgery for advanced epithelial ovarian cancer to examine a model for the cost-effectiveness and cost-related outcomes of surgery compared with neoadjuvant chemotherapy. They developed a decision tree model to examine a model cohort of 15,000 Medicare patients.
Study results showed that when compared to outcomes from primary debulking surgery, neoadjuvant chemotherapy saved $142 million, had 1098 fewer cancer deaths, and added 1355 life-years and 1715 QALYs.
Additionally, when Ms Cole and colleagues conducted a sensitivity analysis, neoadjuvant chemotherapy was the superior treatment option in 99.3% of model simulations.
They also found that neoadjuvant chemotherapy was cost-effective at both $50,000 and $100,000 willingness-to-pay thresholds.
“In the short term, neoadjuvant chemotherapy is cost-saving with improved outcomes,” Ms Cole and colleagues concluded. “However, if primary debulking surgery provides a longer-term survival advantage, it may be cost-effective. Research is needed on the role of patient preferences in trade-offs between survival and quality of life.”
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