Centralization of care for patients with advanced-stage ovarian cancer a cost-effectiveness analysis

• Published in: Cancer Vol. 109; no. 8; pp. 1513 - 1522
• Main Authors: BRISTOW, Robert E, SANTILLAN, Antonio, DIAZ-MONTES, Teresa P, GARDNER, Ginger J, GIUNTOLI, Robert L, MEISNER, Benjamin C, FRICK, Kevin D, ARMSTRONG, Deborah K
• Format: Journal Article
• Language: English
• Published: New York, NY Wiley-Liss 15-04-2007
• Subjects: Antineoplastic Agents - therapeutic use; Biological and medical sciences; Centralized Hospital Services - economics; Centralized Hospital Services - utilization; Combined Modality Therapy; Cost-Benefit Analysis; Decision Support Techniques; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Medical sciences; Ovarian Neoplasms - economics; Ovarian Neoplasms - mortality; Ovarian Neoplasms - therapy; Quality of Life; Referral and Consultation - economics; Tumors; Human; quality-adjusted life years; cost-effectiveness; ovarian cancer; Ovary cancer; Malignant tumor; Care; Female genital diseases; Ovarian diseases; Cancerology; Health economy; Quality; Advanced stage; centralized care; Cost efficiency analysis
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.22561

The objective of this study was to evaluate the cost-effectiveness of centralized referral of patients with advanced-stage epithelial ovarian cancer who underwent primary cytoreductive surgery and adjuvant chemotherapy.
A decision-analysis model was used to compare 2 referral strategies for patients with advanced-stage ovarian cancer: 1) referral to an expert center, with a rate of optimal primary cytoreduction of 75% and utilization of combined intraperitoneal and intravenous adjuvant chemotherapy, and 2) referral to a less experienced center, with a rate of optimal primary cytoreduction of 25% and adjuvant treatment that consisted predominantly of intravenous chemotherapy alone. The cost-effectiveness of each strategy was evaluated from the perspective of society.
A cost-effectiveness analysis revealed that the strategy of expert center referral had an overall cost per patient of $50,652 and had an effectiveness of 5.12 quality-adjusted life years (QALYs). The strategy of referral to a less experienced center carried an overall cost of $39,957 and had an effectiveness of 2.33 QALYs. The expert center strategy was associated with an additional 2.78 QALYs at an incremental cost of $10,695 but was more cost-effective, with a cost-effective ratio of $9893 per QALY compared with $17,149 per QALY for the less experienced center referral strategy. Sensitivity analyses and a Monte Carlo simulation confirmed the robustness of the model.
According to results from the decision-analysis model, centralized referral of patients with ovarian cancer to an expert center was a cost-effective healthcare strategy and represents a paradigm for quality cancer care, delivering superior patient outcomes at an economically affordable cost. Increased efforts to align current patterns of care with a universal strategy of centralized expert referral are warranted.