Evaluation of the cost-effectiveness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (peritonectomy) at the St George Hospital peritoneal surface malignancy program.
BACKGROUND
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are treatment approaches for peritoneal carcinomatosis that has demonstrated improved survival outcomes with acceptable complication rates. This report aims to measure and describe the survival outcomes and health care cost associated with CRS and HIPEC for peritoneal surface malignancies at a centralized tertiary institution in Australia.


METHODS
The expenditure of treatment for 136 consecutive patients who underwent 159 CRS and HIPEC from June 2002 to June 2008 were obtained. Together with their survival outcomes from treatment, a cost-effectiveness analysis was performed.


RESULTS
The average cost of CRS and HIPEC per patient and per life year for appendix cancer is AUD $88,423 (range, AUD $23,933-AUD $299,145) and AUD $37,737/LY; for colorectal cancer is AUD $66,148 (range, AUD $26,079-AUD $409,666) and AUD $29,757/LY; for pseudomyxoma peritonei is AUD $92,308 (range, AUD $11,562-AUD $501,144) and AUD $29,559/LY; for peritoneal mesothelioma is AUD $55,062 (range, AUD $23,261-AUD $94,104) and AUD $20,521/LY; and for other peritoneal surface malignancies is AUD $44,668 (range, AUD $31,592-AUD $70,026) and AUD $22,091/LY.


CONCLUSIONS
This complex surgical treatment results in significant increases in medical costs with a parallel increase in survival for a disease that has been poorly treated, and hence may be considered as cost-effective given the observed life years gained.
Chua
Terence C
TC
Department of Surgery, University of New South Wales, Sydney, NSW, Australia.
Martin
Samantha
S
Saxena
Akshat
A
Liauw
Winston
W
Yan
Tristan D
TD
Zhao
Jing
J
Lok
Irene
I
Morris
David L
DL
D002277:Carcinoma / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000191:economics*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006979:Hyperthermia, Induced / Q000191:economics*; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D011446:Prospective Studies; D015996:Survival Rate