title: Cost-effectiveness analysis of the treatment for intermediate risk endometrial cancer: postoperative brachytherapy vs. observation.
abstract: OBJECTIVE
  To compare the survival, morbidity, and cost of treating women with intermediate risk endometrial cancer with postoperative vaginal cuff brachytherapy versus observation followed by treatment for vaginal recurrence.
  
  
  METHODS
  A cost-effectiveness analysis was performed comparing two treatment strategies for intermediate risk endometrial cancer (Stage IC, IG3, II-tumors limited to the uterus with greater than 50% myometrial invasion or poor differentiation or cervical metastasis). All patients undergo hysterectomy, oophorectomy, and lymphadenectomy: strategy 1-postoperative vaginal cuff brachytherapy, strategy 2-observation. Strategy 2 patients who develop vaginal recurrence undergo diagnostic work-up followed by teletherapy and brachytherapy. All six principles of cost-effectiveness analysis were employed. Importantly, actual payer costs were evaluated, not charges.
  
  
  RESULTS
  Although the treatment for vaginal cuff recurrence is expensive, since only 8% of patients develop a vaginal recurrence, there was a 31% decreased cost by not treating patients with postoperative low-dose rate brachytherapy (strategy 2). Also, although the complication rate for teletherapy is greater than brachytherapy, since only 8% of patients develop a vaginal recurrence and require teletherapy, projected complication rates for the two strategies are similar. Survival would be decreased 3% by withholding postoperative brachytherapy (strategy 2). With postoperative high-dose rate brachytherapy (strategy 1), the cost per life saved would be 38,764 US dollars.
  
  
  CONCLUSIONS
  Using a cost-effectiveness analysis, we have shown that withholding postoperative brachytherapy for patients with intermediate risk endometrial cancer results in a 31% decrease in cost, has a similar radiation complication rate, and results in a 3% decrease in survival.
authors.affiliation: Department of Obstetrics and Gynecology, Medical College of Ohio and Summa Health System, Akron, OH 44309-2090, USA. fanningj@summa-health.org
authors.forename: James
authors.initials: J
authors.lastname: Fanning
authors.forename: Michael L
authors.initials: ML
authors.lastname: Hoffman
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Andrews
authors.forename: Allen W
authors.initials: AW
authors.lastname: Harrah
authors.forename: John J
authors.initials: JJ
authors.lastname: Feldmeier
mesh_terms: D000465:Algorithms; D001918:Brachytherapy / Q000191:economics* / Q000379:methods*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D004307:Dose-Response Relationship, Radiation; D016889:Endometrial Neoplasms / Q000191:economics* / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors