Management strategies for stage IB2 cervical cancer: a cost-effectiveness analysis.
OBJECTIVE
To assess the potential effectiveness and medical costs of three common strategies to manage Stage IB2 squamous cell carcinoma of the cervix (CXCA).


METHODS
A decision analysis model compared three strategies to manage Stage IB2 CXCA: (1) radical hysterectomy with pelvic and para-aortic lymphadenectomy followed by tailored chemoradiation therapy for high-risk patients (RHYST); (2) primary chemoradiation therapy for all patients (CTRT); and (3) neoadjuvant chemotherapy followed by radical hysterectomy and tailored chemoradiation therapy for high-risk patients (NAC).


RESULTS
RHYST was the least expensive strategy with a cost of 284 Million (M) per 10,000 women and a 5-year disease free survival (5-DFS) of 69%. Both NAC and CTRT had similar 5-DFS (69.3% and 70%, respectively); however, both NAC and CTRT were more expensive than RHYST at 299 M and 508 M, respectively. This translated into a higher cost-effectiveness ratio for NAC and CTRT ($43,197 and $72,613, respectively) when compared to RHYST ($41,212). NAC yielded 30 additional survivors compared to RHYST but at a cost of $499,783 per survivor. CTRT was more effective than RHYST with 100 additional survivors but at a substantial cost of $2,240,000 per survivor.


CONCLUSIONS
RHYST is the most cost-effective strategy to manage Stage IB2 CXCA and would be favored in settings where resources are limited. Although NAC and CTRT are reasonable treatment strategies, policymakers must be willing to spend approximately $500,000 per additional survivor (NAC) or $2.2 M per additional survivor (CTRT).
Rocconi
Rodney P
RP
University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 618 South 19th Street, Old Hillman Building-Room 538, Birmingham, AL 35233, USA. rocconi@uab.edu
Estes
Jacob M
JM
Leath
Charles A
CA
Kilgore
Larry C
LC
Huh
Warner K
WK
Straughn
J Michael
JM
D002294:Carcinoma, Squamous Cell / Q000191:economics* / Q000473:pathology / Q000628:therapy*; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D003627:Data Interpretation, Statistical; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics; D017059:Models, Econometric; D020360:Neoadjuvant Therapy / Q000191:economics; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000473:pathology / Q000628:therapy*