Centralization of care for patients with advanced-stage ovarian cancer: A cost-effectiveness analysis

Robert E. Bristow, Antonio Santillan, Teresa P. Diaz-Montes, Ginger J. Gardner, Robert L. Giuntoli, Benjamin C. Meisner, Kevin D. Frick, Deborah K. Armstrong

Research output: Contribution to journalArticle

Abstract

BACKGROUND. The objective of this study was to evaluate the cost-effectiveness of centralized referral of patients with advanced-stage epithelial ovarian cancer who underwent primary cytoreductive surgery and adjuvant chemotherapy. METHODS. A decision-analysis model was used to compare 2 referral strategies for patients with advanced-stage ovarian cancer: 1) referral to an expert center, with a rate of optimal primary cytoreduction of 75% and utilization of combined intraperitoneal and intravenous adjuvant chemotherapy, and 2) referral to a less experienced center, with a rate of optimal primary cytoreduction of 25% and adjuvant treatment that consisted predominantly of intravenous chemotherapy alone. The cost-effectiveness of each strategy was evaluated from the perspective of society. RESULTS. A cost-effectiveness analysis revealed that the strategy of expert center referral had an overall cost per patient of $50,652 and had an effectiveness of 5.12 quality-adjusted life years (QALYs). The strategy of referral to a less experienced center carried an overall cost of $39,957 and had an effectiveness of 2.33 QALYs. The expert center strategy was associated with an additional 2.78 QALYs at an incremental cost of $10,695 but was more cost-effective, with a cost-effective ratio of $9893 per QALY compared with $17,149 per QALY for the less experienced center referral strategy. Sensitivity analyses and a Monte Carlo simulation confirmed the robustness of the model. CONCLUSIONS. According to results from the decision-analysis model, centralized referral of patients with ovarian cancer to an expert center was a cost-effective healthcare strategy and represents a paradigm for quality cancer care, delivering superior patient outcomes at an economically affordable cost. Increased efforts to align current patterns of care with a universal strategy of centralized expert referral are warranted.

Original languageEnglish (US)
Pages (from-to)1513-1522
Number of pages10
JournalCancer
Volume109
Issue number8
DOIs
StatePublished - Apr 15 2007

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Keywords

  • Centralized care
  • Cost-effectiveness
  • Ovarian cancer
  • Quality-adjusted life years

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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