Cost-effectiveness of hyperthermic intraperitoneal chemotherapy at primary cytoreduction of epithelial ovarian cancer based on residual disease status

Abstract

<h3>Objectives:</h3> Hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to confer an overall survival (OS) benefit in a cost-effective manner when used at interval cytoreductive surgery after neoadjuvant chemotherapy for advanced ovarian cancer. Regarding the use of HIPEC at primary cytoreductive surgery (PCS), a recent multicenter retrospective cohort study demonstrated an OS advantage compared to PCS alone in women with stage III epithelial ovarian cancer (EOC). The objective of this study was to evaluate the cost-effectiveness of HIPEC in this setting. <h3>Methods:</h3> A decision analytic cost-effectiveness model of the US health care sector using simulated patients with stage III primary epithelial ovarian cancer was developed for three scenarios: 1) patients with optimal cytoreduction, 2) patients with suboptimal cytoreduction, and 3) all patients regardless of residual disease status. The base case for each model compared two surgical strategies: 1) PCS versus 2) PCS with HIPEC. Model inputs including median survival time, Kaplan-Meier estimates of OS, and costs were obtained from published studies. The time horizon was three years. The primary outcome was incremental cost-effectiveness ratio (ICER) in US dollars per life-year saved (LYS). <h3>Results:</h3> Assuming a willingness-to-pay threshold of $100,000 per LYS, PCS with HIPEC could be considered cost-effective in all three scenarios compared with PCS alone. The ICER was $9,789/LYS in optimally cytoreduced patients, $18,164/LYS in suboptimally cytoreduced patients, and $7,854/LYS for all patients regardless of residual disease burden. <h3>Conclusions:</h3> PCS with HIPEC appears to be a cost-effective strategy for patients with advanced epithelial cancer with all ICERs far below the willingness-to-pay threshold. This warrants further investigation of HIPEC in these clinical settings.