Treatment strategies for stage IB cervical cancer: A cost-effectiveness analysis from Korean, Canadian and U.S. perspectives.

Autor: Lee JY; Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea., Kwon JS; Division of Gynecologic Oncology, University of British Columbia and BC Cancer Agency, Vancouver, BC, Canada., Cohn DE; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, OH, USA., Kim Y; Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea., Smith B; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, OH, USA., Lee TJ; Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea; Department of Health Policy and Management, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea., Kim JW; Department of Obstetrics and Gynecology, Seoul National University, College of Medicine, Seoul, Republic of Korea. Electronic address: kjwksh@snu.ac.kr.
Jazyk: angličtina
Zdroj: Gynecologic oncology [Gynecol Oncol] 2016 Jan; Vol. 140 (1), pp. 83-9. Date of Electronic Publication: 2015 Nov 06.
DOI: 10.1016/j.ygyno.2015.11.007
Abstrakt: Objectives: To assess the cost-effectiveness of two commonly used strategies and an alternative triage strategy for patients with Stage IB cervical cancer in the U.S., Canada, and Korea.
Methods: A Markov state-transition model was constructed to compare three strategies: (1) radical hysterectomy followed by tailored adjuvant therapy (primary surgery), (2) primary chemoradiation, and (3) an MRI-based triage strategy, in which patients without risk factors in preoperative MRI undergo primary surgery and those with risk factors undergo primary chemoradiation. All relevant literature was identified to extract the probability data. Cost data were calculated from the perspective of U.S., Canadian, and Korean payers. Strategies were compared using an incremental cost-effectiveness ratio (ICER). Cost-effectiveness ratios were analyzed separately using data from each country.
Results: Base case analysis showed that the triage strategy was the most cost-effective of the three strategies in all countries at usual willingness-to-pay threshold (Korea: $30,000 per quality-adjusted life year (QALY), Canada and US: $100,000 per QALY). Monte Carlo simulation acceptability curves from Korea indicated that at a willingness-to-pay threshold of $30,000/QALY, triage strategy was the treatment of choice in 71% of simulations. Monte Carlo simulation acceptability curves from US and Canada indicated that at a willingness-to-pay threshold of $100,000/QALY, triage strategy was the treatment of choice in more than half of simulations.
Conclusions: An MRI-based triage strategy was shown to be more cost-effective than primary surgery or primary chemoradiation in the US, Canada, and Korea.
(Copyright © 2015 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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