Jung-Yun Lee1, David E Cohn2, Younhee Kim3, Tae-Jin Lee4, Jason C Barnett5, Jae-Weon Kim6, Yong Woo Jeon7, Kidong Kim8, Sang Min Park9, Sokbom Kang10. 1. Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea. 2. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, OH, USA. 3. Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea. 4. Department of Health Policy and Management, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea. 5. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, San Antonio Military Medical Center, Fort Sam, Houston, TX, USA. 6. Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: kjwksh@snu.ac.kr. 7. Korean Health Promotion Foundation, Seoul, Republic of Korea. 8. Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Gyonggi-do, Republic of Korea. 9. Department of Family Medicine, Seoul National University, College of Medicine, Seoul, Republic of Korea. 10. Center for Uterine Cancer, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.
Abstract
OBJECTIVE: The aim of this study was to determine the cost-effectiveness of selective lymphadenectomy using a preoperative prediction model compared to routine lymphadenectomy for patients undergoing surgery for endometrial cancer in the US and Korea. METHODS: We used a modified Markov model to estimate clinical and economic outcomes for newly diagnosed, apparent early-stage endometrial cancer patients under two different strategies: (1) selective lymphadenectomy, where patients classified as low risk based on the preoperative prediction model did not undergo complete surgical staging, and (2) routine lymphadenectomy, where all patients underwent complete surgical staging. Published data were used to estimate the rates of adjuvant therapy and survival. Costs were calculated from the perspective of US or Korean payers. Cost-effectiveness ratios were analyzed separately using data from each country. RESULTS: Base-case analysis indicated that selective lymphadenectomy was less costly ($6454 vs. $7079 in Korea; $23,995 vs. $26,318 in the US) and more effective (6.91 quality-adjusted life years (QALYs) vs. 6.85 QALYs in Korea; 6.87 QALYs vs. 6.81 QALYs in the US) than routine lymphadenectomy in both countries. This result was robust in a deterministic sensitivity analysis, with the exception of when the utility scores for patients with lymphedema were varied. So long as a modest preference for avoiding lymphedema (disutility of 0.04) was obtained, selective lymphadenectomy remained the dominant strategy. CONCLUSIONS: A selective lymphadenectomy strategy based on a preoperative prediction model was shown to be more cost-effective than routine lymphadenectomy for endometrial cancer patients in the US and Korea.
OBJECTIVE: The aim of this study was to determine the cost-effectiveness of selective lymphadenectomy using a preoperative prediction model compared to routine lymphadenectomy for patients undergoing surgery for endometrial cancer in the US and Korea. METHODS: We used a modified Markov model to estimate clinical and economic outcomes for newly diagnosed, apparent early-stage endometrial cancerpatients under two different strategies: (1) selective lymphadenectomy, where patients classified as low risk based on the preoperative prediction model did not undergo complete surgical staging, and (2) routine lymphadenectomy, where all patients underwent complete surgical staging. Published data were used to estimate the rates of adjuvant therapy and survival. Costs were calculated from the perspective of US or Korean payers. Cost-effectiveness ratios were analyzed separately using data from each country. RESULTS: Base-case analysis indicated that selective lymphadenectomy was less costly ($6454 vs. $7079 in Korea; $23,995 vs. $26,318 in the US) and more effective (6.91 quality-adjusted life years (QALYs) vs. 6.85 QALYs in Korea; 6.87 QALYs vs. 6.81 QALYs in the US) than routine lymphadenectomy in both countries. This result was robust in a deterministic sensitivity analysis, with the exception of when the utility scores for patients with lymphedema were varied. So long as a modest preference for avoiding lymphedema (disutility of 0.04) was obtained, selective lymphadenectomy remained the dominant strategy. CONCLUSIONS: A selective lymphadenectomy strategy based on a preoperative prediction model was shown to be more cost-effective than routine lymphadenectomy for endometrial cancerpatients in the US and Korea.
Authors: Rudy S Suidan; Charlotte C Sun; Scott B Cantor; Andrea Mariani; Pamela T Soliman; Shannon N Westin; Karen H Lu; Sharon H Giordano; Larissa A Meyer Journal: Obstet Gynecol Date: 2018-07 Impact factor: 7.661