Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, United States.
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States.
Gynecol Oncol. 2018 Feb;148(2):329-335. doi: 10.1016/j.ygyno.2017.12.015. Epub 2017 Dec 19.
Advanced stage epithelial ovarian cancer (AEOC) can be treated with either neoadjuvant chemotherapy (NACT) or primary cytoreductive surgery (PCS). Although randomized controlled trials show that NACT is non-inferior in overall survival compared to PCS, there may be improvement in short-term morbidity. We sought to investigate the cost-effectiveness of NACT relative to PCS for AEOC from the US Medicare perspective.
A cost-effectiveness analysis using a Markov model with a 7-month time horizon comparing (1) 3cycles of NACT with carboplatin and paclitaxel (CT), followed by interval cytoreductive surgery, then 3 additional cycles of CT, or (2) PCS followed by 6cycles of CT. Input parameters included probability of chemotherapy complications, surgical complications, treatment completion, treatment costs, and utilities. Model outcomes included costs, life-years gained, quality-adjusted life-years (QALYs) gained, and incremental cost-effectiveness ratios (ICER), in terms of cost per life-year gained and cost per QALY gained. We accounted for differences in surgical complexity by incorporating the cost of additional procedures and the probability of undergoing those procedures. Probabilistic sensitivity analysis (PSA) was performed via Monte Carlo simulations.
NACT resulted in a savings of $7034 per patient with a 0.035 QALY increase compared to PCS; therefore, NACT dominated PCS in the base case analysis. With PSA, NACT was the dominant strategy more than 99% of the time.
In the short-term, NACT is a cost-effective alternative compared to PCS in women with AEOC. These results may translate to longer term cost-effectiveness; however, data from randomized control trials continues to mature.
晚期上皮性卵巢癌（AEOC）可采用新辅助化疗（NACT）或初次细胞减灭术（PCS）进行治疗。尽管随机对照试验显示 NACT 在总生存期方面不劣于 PCS，但短期发病率可能会有所改善。我们旨在从美国医疗保险的角度调查 NACT 相对于 PCS 治疗 AEOC 的成本效益。
使用 Markov 模型进行成本效益分析，该模型具有 7 个月的时间范围，比较了（1）接受 3 个周期的 NACT 加卡铂和紫杉醇（CT），然后进行间隔性细胞减灭术，再接受 3 个周期的 CT，或（2）PCS 后接受 6 个周期的 CT。输入参数包括化疗并发症、手术并发症、治疗完成、治疗成本和效用的概率。模型结果包括成本、获得的生命年、获得的质量调整生命年（QALY）和增量成本效益比（ICER），分别以每获得的生命年的成本和每获得的 QALY 的成本表示。我们通过纳入额外手术的成本和进行这些手术的概率来考虑手术复杂性的差异。通过蒙特卡罗模拟进行概率敏感性分析（PSA）。
与 PCS 相比，NACT 每例患者节省 7034 美元，同时增加了 0.035 个 QALY，因此在基础分析中 NACT 优于 PCS。通过 PSA，NACT 在 99%以上的时间都是主导策略。
在短期内，与 PCS 相比，NACT 是 AEOC 女性的一种具有成本效益的替代方案。这些结果可能转化为更长期的成本效益；然而，随机对照试验的数据仍在不断成熟。
