title: Cost-effectiveness of early-initiated treatment for advanced-stage epithelial ovarian cancer patients: a modeling study.
abstract: OBJECTIVE
  Between diagnosis and primary treatment of patients with epithelial ovarian cancer (EOC), gaps of several weeks exist. Reducing these time intervals may benefit the patient and may lead to a reduction of costs. We explored the cost-effectiveness of early-initiated treatment of patients with suspected advanced-stage EOC compared with that of current treatment.
  
  
  METHODS
  A discrete event simulation was used to synthesize all available evidences and to evaluate the health care costs and effects (quality-adjusted life years [QALYs]) of the 2 treatment strategies over lifetime. Overall survival, progression-free survival, health-related quality of life, and costs of the separate events were assumed to remain equal. Other uncertainties were addressed using deterministic and probabilistic sensitivity analyses.
  
  
  RESULTS
  The treatment times of current and early-initiated treatment were 27 and 24 weeks, respectively. Early-initiated treatment yielded 3.42 QALYs per patient, for a total expected health care cost of €25,654. Current treatment yielded 3.40 QALYs per patient, for a total expected health care cost of €25,607. This resulted in an incremental cost-effectiveness ratio of €2592 per QALY gained for early-initiated treatment compared with that for current treatment. For the willingness to pay for €30,000 or more per QALY, early-initiated treatment had a 100% probability of being cost-effective compared with current treatment under the previously mentioned assumptions.
  
  
  CONCLUSIONS
  Given the current evidence, early-initiated treatment of patients with suspected advanced-stage EOC leads to additional QALYs and seems to be cost-effective compared with current treatment.
authors.affiliation: Departments of *Operating Rooms, †Obstetrics & Gynecology, and ‡Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Tom
authors.initials: T
authors.lastname: Hoyer
authors.forename: Ruud
authors.initials: R
authors.lastname: Bekkers
authors.forename: Hein
authors.initials: H
authors.lastname: Gooszen
authors.forename: Leon
authors.initials: L
authors.lastname: Massuger
authors.forename: Maroeska
authors.initials: M
authors.lastname: Rovers
authors.forename: Janneke P C
authors.initials: JP
authors.lastname: Grutters
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D018803:Models, Economic; D009375:Neoplasms, Glandular and Epithelial / Q000191:economics / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000191:economics / Q000628:therapy*; D013997:Time Factors