title: Cost-effectiveness of early palliative care intervention in recurrent platinum-resistant ovarian cancer.
abstract: OBJECTIVE
  To determine if early palliative care intervention in patients with recurrent, platinum-resistant ovarian cancer is potentially cost saving or cost-effective.
  
  
  METHODS
  A decision model with a 6 month time horizon evaluated routine care versus routine care plus early referral to a palliative medicine specialist (EPC) for recurrent platinum-resistant ovarian cancer. Model parameters included rates of inpatient admissions, emergency department (ED) visits, chemotherapy administration, and quality of life (QOL). From published ovarian cancer data, we assumed baseline rates over the final 6 months: hospitalization 70%, chemotherapy 60%, and ED visit 30%. Published data from a randomized trial evaluating EPC in metastatic lung cancer were used to model odds ratios (ORs) for potential reductions in hospitalization (OR 0.69), chemotherapy (OR 0.77), and emergency department care (OR 0.74) and improvement in QOL (OR 1.07). The costs of hospitalization, ED visit, chemotherapy, and EPC were based on published data. Ranges were used for sensitivity analysis. Effectiveness was quantified in quality adjusted life years (QALYs); survival was assumed equivalent between strategies.
  
  
  RESULTS
  EPC was associated with a cost savings of $1285 per patient over routine care. In sensitivity analysis incorporating QOL, EPC was either dominant or cost-effective, with an incremental cost-effectiveness ratio (ICER) <$50,000/QALY, unless the cost of outpatient EPC exceeded $2400. Assuming no clinical benefit other than QOL (no change in chemotherapy administration, hospitalizations or ED visits), EPC remained highly cost-effective with ICER $37,440/QALY.
  
  
  CONCLUSIONS
  Early palliative care intervention has the potential to reduce costs associated with end of life care in patients with ovarian cancer.
authors.affiliation: Duke University Medical Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Durham, NC 27710, USA. william.lowery@duke.edu
authors.forename: William J
authors.initials: WJ
authors.lastname: Lowery
authors.forename: Ashlei W
authors.initials: AW
authors.lastname: Lowery
authors.forename: Jason C
authors.initials: JC
authors.lastname: Barnett
authors.forename: Micael
authors.initials: M
authors.lastname: Lopez-Acevedo
authors.forename: Paula S
authors.initials: PS
authors.lastname: Lee
authors.forename: Angeles Alvarez
authors.initials: AA
authors.lastname: Secord
authors.forename: Laura
authors.initials: L
authors.lastname: Havrilesky
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D019008:Drug Resistance, Neoplasm; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D009362:Neoplasm Metastasis; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D010166:Palliative Care / Q000191:economics*; D017671:Platinum Compounds / Q000627:therapeutic use; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013727:Terminal Care / Q000191:economics*
chemical_list: D000970:Antineoplastic Agents; D017671:Platinum Compounds
keywords: Cost effectiveness; Palliative care; Platinum resistant ovarian cancer