title: Centralization of care for patients with advanced-stage ovarian cancer: a cost-effectiveness analysis.
abstract: BACKGROUND
  The objective of this study was to evaluate the cost-effectiveness of centralized referral of patients with advanced-stage epithelial ovarian cancer who underwent primary cytoreductive surgery and adjuvant chemotherapy.
  
  
  METHODS
  A decision-analysis model was used to compare 2 referral strategies for patients with advanced-stage ovarian cancer: 1) referral to an expert center, with a rate of optimal primary cytoreduction of 75% and utilization of combined intraperitoneal and intravenous adjuvant chemotherapy, and 2) referral to a less experienced center, with a rate of optimal primary cytoreduction of 25% and adjuvant treatment that consisted predominantly of intravenous chemotherapy alone. The cost-effectiveness of each strategy was evaluated from the perspective of society.
  
  
  RESULTS
  A cost-effectiveness analysis revealed that the strategy of expert center referral had an overall cost per patient of $50,652 and had an effectiveness of 5.12 quality-adjusted life years (QALYs). The strategy of referral to a less experienced center carried an overall cost of $39,957 and had an effectiveness of 2.33 QALYs. The expert center strategy was associated with an additional 2.78 QALYs at an incremental cost of $10,695 but was more cost-effective, with a cost-effective ratio of $9893 per QALY compared with $17,149 per QALY for the less experienced center referral strategy. Sensitivity analyses and a Monte Carlo simulation confirmed the robustness of the model.
  
  
  CONCLUSIONS
  According to results from the decision-analysis model, centralized referral of patients with ovarian cancer to an expert center was a cost-effective healthcare strategy and represents a paradigm for quality cancer care, delivering superior patient outcomes at an economically affordable cost. Increased efforts to align current patterns of care with a universal strategy of centralized expert referral are warranted.
authors.affiliation: 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
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
authors.forename: Antonio
authors.initials: A
authors.lastname: Santillan
authors.forename: Teresa P
authors.initials: TP
authors.lastname: Diaz-Montes
authors.forename: Ginger J
authors.initials: GJ
authors.lastname: Gardner
authors.forename: Robert L
authors.initials: RL
authors.lastname: Giuntoli
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Meisner
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Armstrong
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D002497:Centralized Hospital Services / Q000191:economics* / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000191:economics* / Q000401:mortality / Q000628:therapy; D011788:Quality of Life; D012017:Referral and Consultation / Q000191:economics*
chemical_list: D000970:Antineoplastic Agents