Cost-effectiveness of treatment of early stage endometrial cancer.
OBJECTIVE
The purpose of this study was to determine the average life-years gained and cost per life-year gained in treatment of early endometrial cancer.


METHODS
We performed a decision analysis using statistical models for survival after treatment for Stage I endometrial cancer. Estimates for survival probabilities without treatment, with surgery alone, and with surgery and radiation were derived from the literature. Charges and costs of treatment were estimated based on data from our institution. We calculated the average number of life-years gained and the cost per life-year gained of various treatment options based on these estimates. Sensitivity analyses were performed to determine the effect of uncertainty about parameter estimates on the results derived from our model.


RESULTS
Based on the assumptions of our model, most of the life-years gained in treatment of early endometrial cancer are attributable to hysterectomy, with a very low associated cost. For the "average" woman with endometrial cancer, about 10 life-years are gained from hysterectomy at a cost of $1000 per life-year gained, whereas adjuvant radiation yields on average 1 year of life gained at $4000 per life-year gained. Both life-years gained and cost are dramatically affected by age at diagnosis and to a lesser extent by histologic grade and comorbid medical conditions.


CONCLUSIONS
This analysis suggests that the use of hysterectomy and adjuvant radiation in treatment of early endometrial cancer is a worthwhile use of health care resources. More sophisticated models may help determine the cost-effectiveness of various treatment strategies in specific subgroups of patients.
Ashih
H
H
Institute of Statistics and Decision Sciences, Duke University, Durham, North Carolina, 27710, USA.
Gustilo-Ashby
T
T
Myers
E R
ER
Andrews
J
J
Clarke-Pearson
D L
DL
Berry
D
D
Berchuck
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016889:Endometrial Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008017:Life Expectancy; D008875:Middle Aged; D009367:Neoplasm Staging; D019057:Quality-Adjusted Life Years