C E Koh1,2,3, T Badgery-Parker4,5, G Salkeld4,6, J M Young4,7,5, A G Heriot8, M J Solomon4,9,7,10. 1. Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, New South Wales, Australia. cherry_koh@hotmail.com. 2. Department of Colorectal Surgery, Royal Prince Alfred Hospital, New South Wales, Australia. cherry_koh@hotmail.com. 3. Royal Prince Alfred Institute of Academic Surgery, Royal Prince Alfred Hospital, New South Wales, Australia. cherry_koh@hotmail.com. 4. Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, New South Wales, Australia. 5. Cancer Epidemiology and Cancer Services Research, Sydney School of Public Health, University of Sydney, New South Wales, Australia. 6. Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia. 7. Royal Prince Alfred Institute of Academic Surgery, Royal Prince Alfred Hospital, New South Wales, Australia. 8. Department of Surgical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. 9. Department of Colorectal Surgery, Royal Prince Alfred Hospital, New South Wales, Australia. 10. Discipline of Surgery, Faculty of Medicine, University of Sydney, New South Wales, Australia.
Abstract
BACKGROUND: The rising cost of healthcare is well documented. The purpose of this study was to determine the cost-effectiveness of pelvic exenteration (PE). METHODS: Consecutive patients referred for consideration of PE between 2008 and 2011 were recruited into a prospective non-randomized study that compared quality of life (QoL) between patients who did or did not undergo PE. Information on QoL and cost (in Australian dollars, AUD) was collected at baseline, during admission and up to 24 months after discharge. QoL data were converted into a utility-based measure. Quality-adjusted life-years (QALYs) were calculated. Bottom-up costing was performed. The incremental cost-effectiveness ratio (ICER) was calculated per life-year saved and per QALY. RESULTS: There were 174 patients with sufficient data for analysis. Of these, 139 underwent PE. R0 was achieved in 78·4 per cent of patients. The survival rate at 24 months after PE was 74·8 per cent compared with 43 per cent in those without exenteration (P = 0·001). Treatment costs were significantly higher for patients who had PE compared with those who did not (mean AUD 137 407 versus 79 174; P < 0·001). The ICER was AUD 124 147 (95 per cent c.i. 71 585 to 261 876) per life-year saved and AUD 227 330 (109 974 to 1 100 449) per QALY. Curative PE (R0) was found to be more cost-effective than non-curative PE (R1/R2), with an ICER of AUD 101 518 (60 105 to 200 428) versus 390 712 (74 368 to 82 256 739) per life-year saved. CONCLUSION: Treatment of advanced pelvic cancers is expensive regardless of the treatment intent. For a cost difference of only AUD 58 000 (€38 264), PE offers a chance of cure, and improves survival and QoL.
BACKGROUND: The rising cost of healthcare is well documented. The purpose of this study was to determine the cost-effectiveness of pelvic exenteration (PE). METHODS: Consecutive patients referred for consideration of PE between 2008 and 2011 were recruited into a prospective non-randomized study that compared quality of life (QoL) between patients who did or did not undergo PE. Information on QoL and cost (in Australian dollars, AUD) was collected at baseline, during admission and up to 24 months after discharge. QoL data were converted into a utility-based measure. Quality-adjusted life-years (QALYs) were calculated. Bottom-up costing was performed. The incremental cost-effectiveness ratio (ICER) was calculated per life-year saved and per QALY. RESULTS: There were 174 patients with sufficient data for analysis. Of these, 139 underwent PE. R0 was achieved in 78·4 per cent of patients. The survival rate at 24 months after PE was 74·8 per cent compared with 43 per cent in those without exenteration (P = 0·001). Treatment costs were significantly higher for patients who had PE compared with those who did not (mean AUD 137 407 versus 79 174; P < 0·001). The ICER was AUD 124 147 (95 per cent c.i. 71 585 to 261 876) per life-year saved and AUD 227 330 (109 974 to 1 100 449) per QALY. Curative PE (R0) was found to be more cost-effective than non-curative PE (R1/R2), with an ICER of AUD 101 518 (60 105 to 200 428) versus 390 712 (74 368 to 82 256 739) per life-year saved. CONCLUSION: Treatment of advanced pelvic cancers is expensive regardless of the treatment intent. For a cost difference of only AUD 58 000 (€38 264), PE offers a chance of cure, and improves survival and QoL.
Authors: Daniel Steffens; Jane Young; Bernhard Riedel; Rachael Morton; Linda Denehy; Alexander Heriot; Cherry Koh; Qiang Li; Adrian Bauman; Charbel Sandroussi; Hilmy Ismail; Mbathio Dieng; Nabila Ansari; Neil Pillinger; Sarah O'Shannassy; Sam McKeown; Derek Cunningham; Kym Sheehan; Gino Iori; Jenna Bartyn; Michael Solomon Journal: BMC Cancer Date: 2022-04-22 Impact factor: 4.638
Authors: Daniel Steffens; Jane Young; Paula R Beckenkamp; James Ratcliffe; Freya Rubie; Nabila Ansari; Neil Pillinger; Michael Solomon Journal: Trials Date: 2018-02-17 Impact factor: 2.279