Cost Effectiveness of Interval Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy in Stage III Ovarian Cancer on the Basis of a Randomized Phase III Trial

Simone N Koole, Christiaan van Lieshout, Willemien J van Driel, Evi van Schagen, Karolina Sikorska, Jacobien M Kieffer, Jules H Schagen van Leeuwen, Henk W R Schreuder, Ralph H Hermans, Ignace H de Hingh, Jacobus van der Velden, Henriette J Arts, Leon F A G Massuger, Arend G Aalbers, Victor J Verwaal, Koen K Van de Vijver, Neil K Aaronson, Harm van Tinteren, Gabe S Sonke, Wim H van HartenValesca P Retèl

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

PURPOSE: In the randomized open-label phase III OVHIPEC trial, the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreductive surgery (CRS) improved recurrence-free and overall survival in patients with stage III ovarian cancer. We studied the cost effectiveness of the addition of HIPEC to interval CRS in patients with ovarian cancer.

PATIENTS AND METHODS: We constructed a Markov health-state transition model to measure costs and clinical outcomes. Transition probabilities were derived from the OVHIPEC trial by fitting survival distributions. Incremental cost-effectiveness ratio (ICER), expressed as euros per quality-adjusted life-year (QALY), was calculated from a Dutch societal perspective, with a time horizon of 10 years. Univariable and probabilistic sensitivity analyses were conducted to evaluate the decision uncertainty.

RESULTS: Total health care costs were €70,046 (95% credibility interval [CrI], €64,016 to €76,661) for interval CRS compared with €85,791 (95% CrI, €78,766 to €93,935) for interval CRS plus HIPEC. The mean QALY in the interval CRS group was 2.12 (95% CrI, 1.66 to 2.64 QALYs) and 2.68 (95% CrI, 2.11 to 3.28 QALYs) in the interval CRS plus HIPEC group. The ICER amounted to €28,299/QALY. In univariable sensitivity analysis, the utility of recurrence-free survival and the number of days in the hospital affected the calculated ICER most.

CONCLUSION: On the basis of the trial data, treatment with interval CRS and HIPEC in patients with stage III ovarian cancer was accompanied by a substantial gain in QALYs. The ICER is below the willingness-to-pay threshold in the Netherlands, indicating interval CRS and HIPEC is cost effective for this patient population. These results lend additional support for reimbursing the costs of treating these patients with interval CRS and HIPEC in countries with comparable health care systems.

Original languageEnglish
JournalJournal of Clinical Oncology
Volume37
Issue number23
Pages (from-to)2041-2050
ISSN0732-183X
DOIs
Publication statusPublished - 10. Aug 2019
Externally publishedYes

Fingerprint Dive into the research topics of 'Cost Effectiveness of Interval Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy in Stage III Ovarian Cancer on the Basis of a Randomized Phase III Trial'. Together they form a unique fingerprint.

  • Cite this

    Koole, S. N., van Lieshout, C., van Driel, W. J., van Schagen, E., Sikorska, K., Kieffer, J. M., Schagen van Leeuwen, J. H., Schreuder, H. W. R., Hermans, R. H., de Hingh, I. H., van der Velden, J., Arts, H. J., Massuger, L. F. A. G., Aalbers, A. G., Verwaal, V. J., Van de Vijver, K. K., Aaronson, N. K., van Tinteren, H., Sonke, G. S., ... Retèl, V. P. (2019). Cost Effectiveness of Interval Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy in Stage III Ovarian Cancer on the Basis of a Randomized Phase III Trial. Journal of Clinical Oncology, 37(23), 2041-2050. https://doi.org/10.1200/JCO.19.00594