Abstract
ObjectiveTo analyze the cost of treating women with advanced stage epithelial ovarian cancer (EOC) undergoing primary debulking surgery (PDS) or neo-adjuvant chemotherapy (NACT). MethodsThe Surveillance, Epidemiology, and End Results (SEER) — Medicare database (1992 to 2009) was used to evaluate the 7-month cost of care following PDS and NACT for advanced EOC. Multivariate analyses were used to evaluate differences between women treated by PDS and NACT on cost and survival. ResultsOf the 4506 women eligible for analysis, 82.4% underwent PDS and 17.6% received NACT. Eighty-five percent with stage IIIC and 78.5% with stage IV EOC underwent PDS (p<0.0001). No significant difference in the median cost of care between PDS and NACT existed in women with stage IIIC EOC ($59,801 vs. $59,905). There was a 12% increase in adjusted cost of care for stage IV patients ($63,131 vs. $55,302) who received PDS (p<0.0001). Increasing Charlson score was associated with an increase in 7-month cost of care in both stages. NACT was associated with a decreased 5-year overall survival in women with stage IIIC EOC (HR=1.27, 95% CI: 1.10–1.47) and stage IV EOC (HR=1.19, 95% CI: 1.03–1.37) compared to PDS. ConclusionNACT and PDS are comparable in cost for women with stage IIIC EOC, and PDS is minimally more expensive for women with stage IV EOC. PDS was associated with an increase 5-year overall survival. Future investigations should include cost-effectiveness analyses where additional measures such as quality adjusted life years and propensity scored survival are included.
Highlights
In 2014 the incidence of ovarian cancer in the United States is expected to exceed 21,000 and over 14,000 women are projected to succumb to this disease [1]
We found that primary debulking surgery (PDS) was associated with an increased 5-year overall survival (OS) in women with stage IIIC and IV epithelial ovarian cancer (EOC), we acknowledge that the survival advantage observed in retrospective analyses is highly confounded
There was no cost savings associated with neo-adjuvant chemotherapy (NACT) for stage IIIC
Summary
In 2014 the incidence of ovarian cancer in the United States is expected to exceed 21,000 and over 14,000 women are projected to succumb to this disease [1]. Primary debulking surgery (PDS) followed by doublet chemotherapy with a platinum based agent and a taxane is the first line therapy and offers the greatest survival advantage for women with advanced stage epithelial ovarian cancer (EOC) [2]. One of the main criticisms of both CHORUS and EORTC are the reported optimal debulking rates of 15% and 41%, respectively, which is much lower than what is published elsewhere. This is significant given the clear survival advantage conveyed following optimal tumor resection compared to sub-optimal resection. Wright et al recently published a survival analysis encompassing a period from 1990 to 2007 for women with stage II to IV EOC using SEER-Medicare data
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