A Health Technology Assessment of Hyperthermic Intraperitoneal Chemotherapy Added to Interval Cytoreductive Surgery in Stage III Ovarian Cancer

• Published in: Value in health Vol. 20; no. 9; pp. A433 - A434
• Main Authors: Retèl, VP, van Lieshout, C, Koole, S, Sikorska, K, Sonke, GS, van Driel, WJ, van Harten, WH
• Format: Journal Article
• Language: English
• Published: Lawrenceville Elsevier Science Ltd 01-10-2017
• Subjects: Cancer therapies; Chemotherapy; Clinical outcomes; Clinical trials; Cost analysis; Decision making; End of life decisions; Health care expenditures; Hospitalization; Medical technology; Oncologists; Ovarian cancer; Patient admissions; Prices; Quality adjusted life years; Surgeons; Surgery; Technology assessment; Uptake; Willingness to pay; Netherlands
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.08.204

OBJECTIVES: Hyperthermic intraperitoneal chemotherapy (HIPEC) is a new addition to standard treatment of stage III ovarian cancer with neoadjuvant chemotherapy plus interval cytoreductive surgery (CRS).To support information for policy decision making upon reimbursement, the purpose of this study was to perform a cost-effectiveness analysis and assess organizational implications of introducing HIPEC for ovarian cancer (OVHIPEC). METHODS: A Markov model was build to compare OVHIPEC (in combination with CRS) to standard interval CRS. The analysis was performed from a societal perspective of the Netherlands. Clinical outcomes were derived from a recently presented Dutch randomized controlled trial (OVHIPEC1 study, NCT00426257). Cost data were based on the OVHIPEC1 study, from treatment protocols and standard prices. Costs included neo-adjuvant chemotherapy, surgery -/+ HIPEC, admission days, complications, outpatient visits, end-of-life-care and societal costs. Utilities were derived from literature. Interviews with medical oncologists and gynecological surgeons were conducted to determine organizational implications and possible barriers for the uptake of OVHIPEC. RESULTS: Total healthcare costs were €45,829 (95%-Credible Interval (CrI) 43,199-48,627) for interval CRS compared to €56,921 (95%-CrI 53,312-61,100) for OVHIPEC. OVHIPEC resulted in 1.93 (95%CrI 1.58-2.25) Quality Adjusted Life Years (QALY) and interval CRS only resulted in 1.58 (95%-CrI 1.31-1.85) QALYs.The incremental cost effectiveness ratio was €31,759/QALY. Given a willingness to pay (WTP) threshold of €80,000/QALY in the Netherlands, OVHIPEC had a probability of being cost effective of 83.3%. In case of a €30.000/QALY threshold (more common in Europe), the results will mainly depend on country-specific OVHIPEC- and CRS-intervention costs. Hospital capacity of performing OVHIPEC procedures in the Netherlands was identified as a possible implementation barrier. CONCLUSIONS: Although more costly than interval CRS only, the combination with OVHIPEC resulted in QALY gain. Given the current Dutch WTP threshold, OVHIPEC has a higher probability of being cost effective compared to interval CRS in stage III ovarian cancer.