Cost-effectiveness analysis of the treatment for intermediate risk endometrial cancer: postoperative brachytherapy vs. observation.
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.
Fanning
James
J
Department of Obstetrics and Gynecology, Medical College of Ohio and Summa Health System, Akron, OH 44309-2090, USA. fanningj@summa-health.org
Hoffman
Michael L
ML
Andrews
Stephen J
SJ
Harrah
Allen W
AW
Feldmeier
John J
JJ
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