Cost-utility analysis of treatments for stage IB cervical cancer.
OBJECTIVE
To analyze the cost-utility of two common clinical practices for stage IB cervical cancer patients from provider and societal viewpoints.


METHODS
A DECISION TREE MODEL WAS CONDUCTED TO EXAMINE VALUE FOR EXPENDITURE BETWEEN THE FOLLOWING: (1) radical hysterectomy with pelvic lymph node dissection (RHPLND) with or without postoperative adjuvant therapy according to the risk of recurrence and (2) concurrent chemoradiotherapy (CCRT). The relevant studies were identified to extract the probability data, and meta-analysis was performed. Direct medical costs were estimated from hospital database and medical records review. Direct non-medical costs and utility parameters were obtained through interviews with patients to estimate quality-adjusted life years (QALYs) outcome. The time horizon was according to the life expectancy of Thai women.


RESULTS
From provider viewpoint, RHPLND and CCRT resulted in approximate costs of US $5,281 and US $5,218, respectively. The corresponding costs from societal viewpoint were US $6,533 and US $6,335, respectively. QALYs were 16.40 years for RHPLND and 15.94 years for CCRT. The estimated incremental cost effectiveness ratio of RHPLND in comparison to CCRT from provider and societal viewpoints were US $100/QALY and US $430/QALY, respectively. RHPLND had more cost-effectiveness than CCRT if patients did not need adjuvant therapy. The most effective parameter in model was a direct medical cost of CCRT. At the current ceiling ratio in Thailand, RHPLND provides better value for money than CCRT, with a probability of 75%.


CONCLUSIONS
RHPLND is an efficient treatment for stage IB cervical cancer. This advantage is only for patients who require no adjuvant treatment.
Radiation Oncology Unit, Department of Radiology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Kanyarat
K
Katanyoo
Health Intervention and Technology Assessment Program & Bureau of AIDS, TB and STIs, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
Naiyana
N
Praditsitthikorn
Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Siriwan
S
Tangjitgamol
Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Sumonmal
S
Manusirivithaya
Clinical Epidemiology Unit, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Busaba
B
Supawattanabodee
Cervical cancer; Concurrent chemoradiotherapy; Cost-utility analysis; Radical hysterectomy; Stage IB