Aggressive and complex surgery for advanced ovarian cancer: an economic analysis.
BACKGROUND
In an initial cohort we demonstrated that aggressive surgery correlates with improved survival in patients with advanced ovarian cancer yet the economic implications of maximal surgical efforts are unknown.


OBJECTIVE
To evaluate inpatient costs, survival, and cost-effectiveness of alternative primary surgical approaches among advanced ovarian cancer patients.


METHODS
All patients with a diagnosis of stage IIIC-IV ovarian cancer between 1994 and 2003 were identified and classified by surgical complexity score (SCS) (1=simple, 2=intermediate, and 3=complex). We used clinical and administrative data to estimate costs associated with inpatient stay, survival, and the 5-year cost-effectiveness of complex vs. simple surgery measured in costs per life-year gained.


RESULTS
486 consecutive patients were identified of whom 28%, 50%, and 22% were classified as SCS 1, 2, and 3, respectively. Kaplan-Meier estimated survival differed by SCS group (p<0.001) with an average survival gain of 1.32 years with complex vs. simple surgery (SCS group 3 vs. 1). Inpatient costs significantly differed between SCS groups (mean costs SCS 1: $21,914; SCS 2: $27,408; SCS 3: $33,678; p<0.001). Analyses suggest incremental cost-effectiveness ratios of $4950 and $8912 per life-year gained, comparing SCS groups 2 vs. 1 and 3 vs. 1 respectively.


CONCLUSIONS
Complex surgery for ovarian cancer cytoreduction carries a survival benefit at increased direct medical cost. However, preliminary cost-effectiveness results suggest complex surgery provides good value for money spent. Future research on the cost and quality of life implications of surgical morbidity during follow-up is warranted to formally assess the cost-effectiveness of complex vs. simple surgical procedures.
Aletti
Giovanni D
GD
Department of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
Podratz
Karl C
KC
Moriarty
James P
JP
Cliby
William A
WA
Long
Kirsten Hall
KH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000191:economics* / Q000379:methods*; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000191:economics* / Q000473:pathology / Q000601:surgery*