Is centralization of ovarian cancer care warranted? A cost-effectiveness analysis.
OBJECTIVE
To evaluate the cost-effectiveness of tertiary referral care for ovarian cancer patients in the Netherlands.


METHODS
We collected clinical and registry data on 1077 newly diagnosed ovarian cancer patients treated from 1996-2003 in a random sample of Dutch hospitals. Decision modelling was used to compare the cost-effectiveness of treatment in general hospitals, semi-specialized hospitals, and tertiary care centers. The actual direct medical costs of ovarian cancer treatment were evaluated. Long-term outcomes in terms of costs, quality-adjusted life-years (QALYs), and incremental costs per QALY gained were estimated. To assess uncertainty, multivariable sensitivity analyses and scenario analyses were performed.


RESULTS
Treatment of ovarian cancer patients in semi-specialized hospitals costs on average euro882 more than in general hospitals (95% confidence interval -720 to 2462) and yields 0.12 additional QALYs (95% CI 0.02 to 0.22), resulting in an incremental cost-effectiveness ratio (ICER) of euro7135. Patients treated in tertiary care centers incurred again higher costs (euro10,591, 95% CI 8757 to 12,480) and also higher QALYs (0.10, 95% CI 0 to 0.21), resulting in an ICER of euro102,642 compared to semi-specialized hospitals. If the optimal debulking rate in tertiary care centers would increase to 70%, costs could drop below euro30,000 per QALY.


CONCLUSIONS
Current treatment of ovarian cancer patients in semi-specialized hospital settings is a cost-effective strategy, while treatment in tertiary care centers becomes only cost-effective when better surgical results would be achieved.
Greving
Jacoba P
JP
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Internal mailbox Str 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands. J.P.Greving@umcutrecht.nl
Vernooij
Flora
F
Heintz
A Peter M
AP
van der Graaf
Yolanda
Y
Buskens
Erik
E
D002173:Cancer Care Facilities / Q000191:economics* / Q000458:organization & administration*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006769:Hospitals, General / Q000191:economics / Q000458:organization & administration; D006801:Humans; D009367:Neoplasm Staging; D009426:Netherlands; D016522:Oncology Service, Hospital / Q000191:economics / Q000458:organization & administration; D010051:Ovarian Neoplasms / Q000191:economics* / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D011788:Quality of Life; D016896:Treatment Outcome