Prevention of adhesion formation after radical hysterectomy using a sodium hyaluronate-carboxymethylcellulose (HA-CMC) barrier: a cost-effectiveness analysis.
OBJECTIVE
To evaluate the cost-effectiveness of an adhesion prevention strategy compared to routine care, in which no adhesion prevention measures are taken, through a decision analysis model in the clinical setting of patients undergoing radical hysterectomy and pelvic lymphadenectomy for Stage IB cervical cancer.


METHODS
A decision analysis model compared two strategies to manage the risk of adhesion-related morbidity following radical hysterectomy for Stage IB cervical cancer: (1) routine care with no adhesion prevention measures, and (2) the intervention strategy with a HA-CMC anti-adhesion barrier. The cost-effectiveness of each strategy was evaluated from the perspective of society and that of a third party payer.


RESULTS
From the perspective of society, the HA-CMC strategy had an overall cost per patient of $1932 and effectiveness of 7.901 QALYs and dominated the routine care strategy, which had a cost per patient of $3043 and effectiveness of 7.805 QALYs. From the perspective of a third party payer, the HA-CMC strategy had an overall cost per patient of $1247 and effectiveness of 7.987 QALYs and dominated the routine care strategy, which had a cost per patient of $1629 and effectiveness of 7.970 QALYs. A series of one-way sensitivity analyses confirmed the robustness of the model.


CONCLUSIONS
Under a conservative set of clinical and economic assumptions, an adhesion prevention strategy utilizing a HA-CMC barrier in patients undergoing radical hysterectomy for Stage IB cervical cancer is cost-effective from both the perspective of society as a whole and that of a third party payer.
Bristow
Robert E
RE
The Kelly Gynecologic Oncology Service, Department of Obstetrics and Gynecology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. rbristo@jhmi.edu
Santillan
Antonio
A
Diaz-Montes
Teresa P
TP
Gardner
Ginger J
GJ
Giuntoli
Robert L
RL
Peeler
Susan T
ST
D002266:Carboxymethylcellulose Sodium / Q000008:administration & dosage*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016527:Drug Costs; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007044:Hysterectomy / Q000009:adverse effects* / Q000191:economics; D007349:Insurance, Health, Reimbursement; D007415:Intestinal Obstruction / Q000209:etiology / Q000517:prevention & control*; D007421:Intestine, Small; D018803:Models, Economic; D000267:Tissue Adhesions / Q000150:complications / Q000517:prevention & control; D002583:Uterine Cervical Neoplasms / Q000601:surgery*
C118198:Seprafilm; D006820:Hyaluronic Acid; D002266:Carboxymethylcellulose Sodium