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Comparative Study
. 2015 Jul;26(3):171-8.
doi: 10.3802/jgo.2015.26.3.171. Epub 2015 Apr 17.

Cost-effectiveness of para-aortic lymphadenectomy before chemoradiotherapy in locally advanced cervical cancer

Jung Yun Lee  1 , Younhee Kim  2 , Tae Jin Lee  3 , Yong Woo Jeon  4 , Kidong Kim  5 , Hyun Hoon Chung  6 , Hak Jae Kim  7 , Sang Min Park  8 , Jae Weon Kim  6
Affiliations
Comparative Study

Cost-effectiveness of para-aortic lymphadenectomy before chemoradiotherapy in locally advanced cervical cancer

Jung Yun Lee et al. J Gynecol Oncol. 2015 Jul.

Abstract

Objective: To evaluate the cost-effectiveness of nodal staging surgery before chemoradiotherapy (CRT) for locally advanced cervical cancer in the era of positron emission tomography/computed tomography (PET/CT).

Methods: A modified Markov model was constructed to evaluate the cost-effectiveness of para-aortic staging surgery before definite CRT when no uptake is recorded in the para-aortic lymph nodes (PALN) on PET/CT. Survival and complication rates were estimated based on the published literature. Cost data were obtained from the Korean Health Insurance Review and Assessment Service. Strategies were compared using an incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed, including estimates for the performance of PET/CT, postoperative complication rate, and varying survival rates according to the radiation field.

Results: We compared two strategies: strategy 1, pelvic CRT for all patients; and strategy 2, nodal staging surgery followed by extended-field CRT when PALN metastasis was found and pelvic CRT otherwise. The ICER for strategy 2 compared to strategy 1 was $19,505 per quality-adjusted life year (QALY). Under deterministic sensitivity analyses, the model was relatively sensitive to survival reduction in patients who undergo pelvic CRT alone despite having occult PALN metastasis. A probabilistic sensitivity analysis demonstrated the robustness of the case results, with a 91% probability of cost-effectiveness at the willingness-to-pay thresholds of $60,000/QALY.

Conclusion: Nodal staging surgery before definite CRT may be cost-effective when PET/CT imaging shows no evidence of PALN metastasis. Prospective trials are warranted to transfer these results to guidelines.

Keywords: Chemoradiotherapy; Cost-Benefit Analysis; Postoperative Complications; Quality-Adjusted Life Years; Uterine Cervical Neoplasms.

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Conflict of interest statement

CONFLICT OF INTEREST: Jae-Weon Kim serves as an editor of the JGO but had no role in the decision to publish this article. Otherwise, no potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Schematic model. CRT, chemoradiotherapy; EFRT, extended-field radiation therapy; PALN, para-aortic lymph node; PET/CT, positron emission tomography/computed tomography.
Fig. 2
Fig. 2. Cost-effectiveness (CE) acceptability curve comparing two strategies. CRT, chemoradiotherapy.
See this image and copyright information in PMC

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References

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