Centralization of care for patients with advanced-stage ovarian cancer a cost-effectiveness analysis
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...
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| Published in: | Cancer Vol. 109; no. 8; pp. 1513 - 1522 |
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| Main Authors: | , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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Wiley-Liss
15-04-2007
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| Abstract | 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. |
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| AbstractList | BACKGROUNDThe 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.METHODSA 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.RESULTSA 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.CONCLUSIONSAccording 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. 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. |
| Author | GARDNER, Ginger J MEISNER, Benjamin C BRISTOW, Robert E FRICK, Kevin D ARMSTRONG, Deborah K DIAZ-MONTES, Teresa P GIUNTOLI, Robert L SANTILLAN, Antonio |
| Author_xml | – sequence: 1 givenname: Robert E surname: BRISTOW fullname: BRISTOW, Robert E organization: The Kelly Gynecologic Oncology Service, Department of Obstetrics and Gynecology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States – sequence: 2 givenname: Antonio surname: SANTILLAN fullname: SANTILLAN, Antonio organization: Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States – sequence: 3 givenname: Teresa P surname: DIAZ-MONTES fullname: DIAZ-MONTES, Teresa P organization: The Kelly Gynecologic Oncology Service, Department of Obstetrics and Gynecology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States – sequence: 4 givenname: Ginger J surname: GARDNER fullname: GARDNER, Ginger J organization: The Kelly Gynecologic Oncology Service, Department of Obstetrics and Gynecology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States – sequence: 5 givenname: Robert L surname: GIUNTOLI fullname: GIUNTOLI, Robert L organization: The Kelly Gynecologic Oncology Service, Department of Obstetrics and Gynecology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States – sequence: 6 givenname: Benjamin C surname: MEISNER fullname: MEISNER, Benjamin C organization: The Kelly Gynecologic Oncology Service, Department of Obstetrics and Gynecology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States – sequence: 7 givenname: Kevin D surname: FRICK fullname: FRICK, Kevin D organization: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States – sequence: 8 givenname: Deborah K surname: ARMSTRONG fullname: ARMSTRONG, Deborah K organization: Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States |
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| Keywords | 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 |
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| SubjectTerms | 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 |
| Title | Centralization of care for patients with advanced-stage ovarian cancer a cost-effectiveness analysis |
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