title: Costs of treatment for elderly women with advanced ovarian cancer in a Medicare population.
abstract: OBJECTIVE
  To analyze the cost of treating women with advanced stage epithelial ovarian cancer (EOC) undergoing primary debulking surgery (PDS) or neo-adjuvant chemotherapy (NACT).
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results (SEER) - Medicare database (1992 to 2009) was used to evaluate the 7-month cost of care following PDS and NACT for advanced EOC. Multivariate analyses were used to evaluate differences between women treated by PDS and NACT on cost and survival.
  
  
  RESULTS
  Of the 4506 women eligible for analysis, 82.4% underwent PDS and 17.6% received NACT. Eighty-five percent with stage IIIC and 78.5% with stage IV EOC underwent PDS (p<0.0001). No significant difference in the median cost of care between PDS and NACT existed in women with stage IIIC EOC ($59,801 vs. $59,905). There was a 12% increase in adjusted cost of care for stage IV patients ($63,131 vs. $55,302) who received PDS (p<0.0001). Increasing Charlson score was associated with an increase in 7-month cost of care in both stages. NACT was associated with a decreased 5-year overall survival in women with stage IIIC EOC (HR=1.27, 95% CI: 1.10-1.47) and stage IV EOC (HR=1.19, 95% CI: 1.03-1.37) compared to PDS.
  
  
  CONCLUSIONS
  NACT and PDS are comparable in cost for women with stage IIIC EOC, and PDS is minimally more expensive for women with stage IV EOC. PDS was associated with an increase 5-year overall survival. Future investigations should include cost-effectiveness analyses where additional measures such as quality adjusted life years and propensity scored survival are included.
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine-Medical Center, Orange, CA USA. Electronic address: gforde@uci.edu.
authors: G K
authors: GK
authors: Forde
authors: Department of Epidemiology, University of California, Irvine, CA USA.
authors: J
authors: J
authors: Chang
authors: Department of Epidemiology, University of California, Irvine, CA USA.
authors: A
authors: A
authors: Ziogas
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine-Medical Center, Orange, CA USA.
authors: K
authors: K
authors: Tewari
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine-Medical Center, Orange, CA USA.
authors: R E
authors: RE
authors: Bristow
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D006278:Medicare / Q000191:economics*; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D018426:SEER Program; D014481:United States
keywords: Chemotherapy; Cost; Cost-effectiveness; Ovarian cancer; SEER-Medicare; Surgery