CN1 - Treatment Strategies For Stage Ib Cervical Cancer: A Cost-Effectiveness Analysis

Abstract

To access the cost-effectiveness of two common strategies and alternative triage strategy for patients with stage IB cervical cancer A Markov state transition model was constructed to compare three strategies: (1) radical hysterectomy followed by tailored adjuvant therapy (RH+TA); (2) primary chemoradiation (pCCRT); (3) Triage strategy, in which patients without risk in preoperative MRI undergo primary surgery and those with any risk factors in MRI undergo primary CCRT. All relevant literatures were identified to extract the probability data. Direct medical costs were estimated from Korean National Health Insurance database. Strategies were compared using incremental cost per year of life saved (YLS). RH+TA strategy was the least expensive strategy. Although pCCRT strategy had similar outcomes, pCCRT strategy was more expensive than RH+TA ($10,945 vs. $7,257). A sensitivity analysis showed that RH+TA is cost-effective than pCCRT when the percentage of patients who require no adjuvant therapy after radical hysterectomy exceeds 30%. Triage strategy was more expensive and more effective, with an incremental cost-effectiveness ratio (ICER) of $39,271 per year of life saved (YLS) compared to RH+TA. Results are relatively sensitive to variation in how the rate of patients who require adjuvant therapy after surgery decrease in MRI-based strategy. RH+TA is cost-effective than pCCRT in Stage IB cervical cancer. Given the current high rates of adjuvant therapy after primary radical surgery in Stage IB cervical cancer, MRI-based strategy has potential to be cost-effective when compared to RH+TA at high test performance and at the lower range of test costs.