title: Improving NCCN guideline-adherent care for ovarian cancer: Value of an intervention.
abstract: OBJECTIVE
  To estimate the potential cost-effectiveness of an intervention to improve adherence to National Comprehensive Cancer Network (NCCN) guideline-based care for ovarian cancer.
  
  
  METHODS
  A modified Markov model with a 5-year time horizon estimated the potential cost-effectiveness of an intervention (AD-INT) to improve NCCN-guideline adherence compared to status quo (SQ) levels of adherence. Data were obtained from a population-based analysis of National Cancer Data Base records for ovarian cancer diagnosed from 1998 to 2002 (N=47,160). Cohorts were defined by race and adherence to NCCN guideline-based care. Costs were estimated using 2014 Medicare reimbursements. Incremental cost-effectiveness ratios (ICERs) were calculated in 2014 US dollars per year of life saved (YLS) using the standard threshold of $50,000/YLS. We simulated an AD-INT that reduced non-adherence by 25% and cost at least $100 per patient. One-way sensitivity analyses were performed.
  
  
  RESULTS
  Although the individual components of guideline-adherent care are more costly than non-adherent care, a reasonably effective AD-INT is also highly likely to be cost-effective. An AD-INT costing $100 per patient and reducing non-adherence by 25% is cost-effective with an ICER of $22/YLS compared with SQ, while interventions costing over $1000 remain cost-effective, up to a per-patient intervention cost of up to $8000 (targeting only blacks) or $4000 (targeting all patients).
  
  
  CONCLUSIONS
  An ovarian cancer intervention that moderately decreases racial disparities in NCCN guideline adherent care or improves adherence for all is potentially cost-effective. Further research may determine which modifiable factors may be targeted to help reduce adherence disparities.
authors.affiliation: Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dottino
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Cliby
authors.affiliation: Duke Cancer Institute, Durham, NC 27710, USA; Department of Obstetrics and Gynecology, Division of Clinical and Epidemiological Research, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Evan R
authors.initials: ER
authors.lastname: Myers
authors.affiliation: Division of Gynecologic Oncology, University of California, Irvine School of Medicine, Orange, CA 92697, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
authors.affiliation: Duke Cancer Institute, Durham, NC 27710, USA; Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC 27710, USA. Electronic address: havri001@mc.duke.edu.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D010051:Ovarian Neoplasms / Q000191:economics* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D014481:United States
keywords: Adherence; Cost; Cost-effectiveness; Disparities; Guidelines; Ovarian cancer; Race