title: Cost-effectiveness of pelvic exenteration for locally advanced malignancy.
abstract: BACKGROUND
  The rising cost of healthcare is well documented. The purpose of this study was to determine the cost-effectiveness of pelvic exenteration (PE).
  
  
  METHODS
  Consecutive patients referred for consideration of PE between 2008 and 2011 were recruited into a prospective non-randomized study that compared quality of life (QoL) between patients who did or did not undergo PE. Information on QoL and cost (in Australian dollars, AUD) was collected at baseline, during admission and up to 24 months after discharge. QoL data were converted into a utility-based measure. Quality-adjusted life-years (QALYs) were calculated. Bottom-up costing was performed. The incremental cost-effectiveness ratio (ICER) was calculated per life-year saved and per QALY.
  
  
  RESULTS
  There were 174 patients with sufficient data for analysis. Of these, 139 underwent PE. R0 was achieved in 78·4 per cent of patients. The survival rate at 24 months after PE was 74·8 per cent compared with 43 per cent in those without exenteration (P = 0·001). Treatment costs were significantly higher for patients who had PE compared with those who did not (mean AUD 137 407 versus 79 174; P < 0·001). The ICER was AUD 124 147 (95 per cent c.i. 71 585 to 261 876) per life-year saved and AUD 227 330 (109 974 to 1 100 449) per QALY. Curative PE (R0) was found to be more cost-effective than non-curative PE (R1/R2), with an ICER of AUD 101 518 (60 105 to 200 428) versus 390 712 (74 368 to 82 256 739) per life-year saved.
  
  
  CONCLUSIONS
  Treatment of advanced pelvic cancers is expensive regardless of the treatment intent. For a cost difference of only AUD 58 000 (€38 264), PE offers a chance of cure, and improves survival and QoL.
authors: Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, New South Wales, Australia. cherry_koh@hotmail.com.|Department of Colorectal Surgery, Royal Prince Alfred Hospital, New South Wales, Australia. cherry_koh@hotmail.com.|Royal Prince Alfred Institute of Academic Surgery, Royal Prince Alfred Hospital, New South Wales, Australia. cherry_koh@hotmail.com.
authors: C E
authors: CE
authors: Koh
authors: Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, New South Wales, Australia.|Cancer Epidemiology and Cancer Services Research, Sydney School of Public Health, University of Sydney, New South Wales, Australia.
authors: T
authors: T
authors: Badgery-Parker
authors: Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, New South Wales, Australia.|Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia.
authors: G
authors: G
authors: Salkeld
authors: Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, New South Wales, Australia.|Royal Prince Alfred Institute of Academic Surgery, Royal Prince Alfred Hospital, New South Wales, Australia.|Cancer Epidemiology and Cancer Services Research, Sydney School of Public Health, University of Sydney, New South Wales, Australia.
authors: J M
authors: JM
authors: Young
authors: Department of Surgical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors: A G
authors: AG
authors: Heriot
authors: Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, New South Wales, Australia.|Department of Colorectal Surgery, Royal Prince Alfred Hospital, New South Wales, Australia.|Royal Prince Alfred Institute of Academic Surgery, Royal Prince Alfred Hospital, New South Wales, Australia.|Discipline of Surgery, Faculty of Medicine, University of Sydney, New South Wales, Australia.
authors: M J
authors: MJ
authors: Solomon
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D009517:New South Wales; D065228:Non-Randomized Controlled Trials as Topic; D010385:Pelvic Exenteration / Q000191:economics*; D010386:Pelvic Neoplasms / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D014739:Victoria