Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer

Roelien van de Vrie; Hannah S van Meurs; Marianne J Rutten; Christiana A Naaktgeboren; Brent C Opmeer; Katja N Gaarenstroom; Toon van Gorp; Henk G Ter Brugge; Ward Hofhuis; Henk W R Schreuder; Henriette J G Arts; Petra L M Zusterzeel; Johanna M A Pijnenborg; Maarten van Haaften; Mirjam J A Engelen; Erik A Boss; M Caroline Vos; Kees G Gerestein; Eltjo M J Schutter; Gemma G Kenter; Patrick M M Bossuyt; Ben Willem Mol; Marrije R Buist

doi:10.1016/j.ygyno.2017.06.019

Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer

Gynecol Oncol. 2017 Sep;146(3):449-456. doi: 10.1016/j.ygyno.2017.06.019. Epub 2017 Jun 20.

Authors

Roelien van de Vrie¹, Hannah S van Meurs¹, Marianne J Rutten¹, Christiana A Naaktgeboren², Brent C Opmeer³, Katja N Gaarenstroom⁴, Toon van Gorp⁵, Henk G Ter Brugge⁶, Ward Hofhuis⁷, Henk W R Schreuder⁸, Henriette J G Arts⁹, Petra L M Zusterzeel¹⁰, Johanna M A Pijnenborg¹¹, Maarten van Haaften¹², Mirjam J A Engelen¹³, Erik A Boss¹⁴, M Caroline Vos¹¹, Kees G Gerestein¹⁵, Eltjo M J Schutter¹⁶, Gemma G Kenter¹, Patrick M M Bossuyt², Ben Willem Mol¹⁷, Marrije R Buist¹⁸

Affiliations

¹ Department of Gynecology, Center for Gynecologic Oncology Amsterdam, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
² Department of Epidemiology, Center for Gynecologic Oncology Amsterdam, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
³ Clinical Research Unit, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
⁴ Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
⁵ Department of Gynecology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
⁶ Department of Gynecology, Isala Hospital, PO Box 10400, 8000 GK Zwolle, The Netherlands.
⁷ Department of Gynecology, Sint Franciscus Gasthuis, PO Box 10900, 3004 BA Rotterdam, The Netherlands.
⁸ Department of Gynecologic oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
⁹ Department of Gynecology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
¹⁰ Department of Gynecology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
¹¹ Department of Gynecology, Elisabeth-Tweesteden Hospital, PO Box 90151, 5000 LC Tilburg, The Netherlands.
¹² Department of Gynecology, Diakonessenhuis, PO Box 80250, 3508 TG Utrecht, The Netherlands.
¹³ Department of Gynecology, Atrium Medical Center, PO Box 4446, 6401 CX Heerlen, The Netherlands.
¹⁴ Department of Gynecology, Máxima Medical Center, PO Box 7777, 5500 MB Veldhoven, The Netherlands.
¹⁵ Department of Gynecology, Meander Medical Center, PO Box 1502, 3800 BM Amersfoort, The Netherlands.
¹⁶ Department of Gynecology, Medical Spectrum Twente, PO Box 50 000, 7500 KA Enschede, The Netherlands.
¹⁷ The Robinson Institute, School of Pediatrics and Reproductive Health, University of Adelaide, 55 King William Road, North Adelaide, SA 5006, Australia.
¹⁸ Department of Gynecology, Center for Gynecologic Oncology Amsterdam, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: m.r.buist@amc.nl.

PMID: 28645428
DOI: 10.1016/j.ygyno.2017.06.019

Abstract

Objective: To evaluate the cost-effectiveness of a diagnostic laparoscopy prior to primary cytoreductive surgery to prevent futile primary cytoreductive surgery (i.e. leaving >1cm residual disease) in patients suspected of advanced stage ovarian cancer.

Methods: An economic analysis was conducted alongside a randomized controlled trial in which patients suspected of advanced stage ovarian cancer who qualified for primary cytoreductive surgery were randomized to either laparoscopy or primary cytoreductive surgery. Direct medical costs from a health care perspective over a 6-month time horizon were analyzed. Health outcomes were expressed in quality-adjusted life-years (QALYs) and utility was based on patient's response to the EQ-5D questionnaires. We primarily focused on direct medical costs based on Dutch standard prices.

Results: We studied 201 patients, of whom 102 were randomized to laparoscopy and 99 to primary cytoreductive surgery. No significant difference in QALYs (utility=0.01; 95% CI 0.006 to 0.02) was observed. Laparoscopy reduced the number of futile laparotomies from 39% to 10%, while its costs were € 1400 per intervention, making the overall costs of both strategies comparable (difference € -80 per patient (95% CI -470 to 300)). Findings were consistent across various sensitivity analyses.

Conclusion: In patients with suspected advanced stage ovarian cancer, a diagnostic laparoscopy reduced the number of futile laparotomies, without increasing total direct medical health care costs, or adversely affecting complications or quality of life.

Keywords: Cost-effectiveness; Cytoreductive surgery; Diagnostic laparoscopy; Ovarian cancer; Quality of life.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Chemotherapy, Adjuvant / economics
Cost-Benefit Analysis
Cytoreduction Surgical Procedures / economics*
Diagnostic Techniques, Surgical / economics
Female
Health Care Costs*
Humans
Laparoscopy / economics*
Medical Futility
Middle Aged
Neoadjuvant Therapy / economics
Neoplasm Staging
Ovarian Neoplasms / diagnosis*
Ovarian Neoplasms / drug therapy
Ovarian Neoplasms / pathology
Ovarian Neoplasms / surgery*
Quality of Life
Quality-Adjusted Life Years