Cost-effectiveness analysis of strategies for the surgical management of grade 1 endometrial adenocarcinoma.
OBJECTIVE
To estimate the costs and outcomes of various strategies used for the management of grade 1 endometrial cancer.


METHODS
A cost-effectiveness analysis compared three strategies for the management of grade 1 endometrial cancer: 1) surgical staging in all patients (including hysterectomy and lymphadenectomy); 2) frozen section following hysterectomy with surgical staging based on the results of tumor grade and depth of myometrial invasion; and 3) hysterectomy without surgical staging (no staging). Surgical probabilities and recurrence rates were estimated from published data. Actual payer costs of surgery, radiation therapy, and chemotherapy were estimated for each strategy. Cost-effectiveness ratios were estimated for each strategy. Sensitivity analyses evaluated the costs of radiation and survival estimates used in the model.


RESULTS
For the estimated 10,000 women diagnosed annually with grade 1 endometrial cancer in the United States, the annual cost of surgical staging is $240.4 million, compared with $252.4 million for frozen section and $255.8 million for no staging. Five-year disease-free survival for surgical staging is 87.9%, compared with 87.3% for frozen section and 86.7% for no staging. This translates into a lower cost-effectiveness ratio for surgical staging ($27,337) compared with frozen section ($28,913) or no staging ($29,513). Surgical staging yielded 64 additional disease-free patients per 10,000 patients compared with frozen section and 126 additional disease-free patients compared with no staging. Use of adjuvant radiation therapy was the lowest in the surgical staging strategy (13%).


CONCLUSIONS
Surgical staging of all patients with grade 1 endometrial cancer is the most cost-effective strategy and decreases the use of radiation therapy without negatively impacting survival.
Cohn
David E
DE
Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, Ohio, USA. David.Cohn@osumc.edu
Huh
Warner K
WK
Fowler
Jeffrey M
JM
Straughn
J Michael
JM
D000230:Adenocarcinoma / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D005629:Frozen Sections / Q000191:economics; D013509:Gynecologic Surgical Procedures / Q000191:economics* / Q000379:methods; D006801:Humans; D007044:Hysterectomy / Q000191:economics; D007432:Intraoperative Period; D008197:Lymph Node Excision / Q000191:economics; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010052:Ovariectomy / Q000191:economics; D018714:Radiotherapy, Adjuvant; D012680:Sensitivity and Specificity; D016896:Treatment Outcome