title: Treatment strategies for stage IB cervical cancer: A cost-effectiveness analysis from Korean, Canadian and U.S. perspectives.
abstract: OBJECTIVE
  To assess the cost-effectiveness of two commonly used strategies and an alternative triage strategy for patients with Stage IB cervical cancer in the U.S., Canada, and Korea.
  
  
  METHODS
  A Markov state-transition model was constructed to compare three strategies: (1) radical hysterectomy followed by tailored adjuvant therapy (primary surgery), (2) primary chemoradiation, and (3) an MRI-based triage strategy, in which patients without risk factors in preoperative MRI undergo primary surgery and those with risk factors undergo primary chemoradiation. All relevant literature was identified to extract the probability data. Cost data were calculated from the perspective of U.S., Canadian, and Korean payers. Strategies were compared using an incremental cost-effectiveness ratio (ICER). Cost-effectiveness ratios were analyzed separately using data from each country.
  
  
  RESULTS
  Base case analysis showed that the triage strategy was the most cost-effective of the three strategies in all countries at usual willingness-to-pay threshold (Korea: $30,000 per quality-adjusted life year (QALY), Canada and US: $100,000 per QALY). Monte Carlo simulation acceptability curves from Korea indicated that at a willingness-to-pay threshold of $30,000/QALY, triage strategy was the treatment of choice in 71% of simulations. Monte Carlo simulation acceptability curves from US and Canada indicated that at a willingness-to-pay threshold of $100,000/QALY, triage strategy was the treatment of choice in more than half of simulations.
  
  
  CONCLUSIONS
  An MRI-based triage strategy was shown to be more cost-effective than primary surgery or primary chemoradiation in the US, Canada, and Korea.
authors.affiliation: Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jung-Yun
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Division of Gynecologic Oncology, University of British Columbia and BC Cancer Agency, Vancouver, BC, Canada.
authors.forename: Janice S
authors.initials: JS
authors.lastname: Kwon
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Cohn
authors.affiliation: Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
authors.forename: Younhee
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: Blair
authors.initials: B
authors.lastname: Smith
authors.affiliation: Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea; Department of Health Policy and Management, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
authors.forename: Tae-Jin
authors.initials: TJ
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University, College of Medicine, Seoul, Republic of Korea. Electronic address: kjwksh@snu.ac.kr.
authors.forename: Jae-Weon
authors.initials: JW
authors.lastname: Kim
mesh_terms: D002170:Canada; D059248:Chemoradiotherapy / Q000191:economics / Q000379:methods; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000379:methods; D008197:Lymph Node Excision / Q000191:economics / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008390:Markov Chains; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic; D056910:Republic of Korea; D014218:Triage / Q000191:economics / Q000379:methods; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000201:enzymology* / Q000473:pathology / Q000628:therapy*
keywords: Cervical cancer; Cost-effectiveness; MRI; Primary chemoradiation; Radical hysterectomy; Triage strategy