Los Angeles, CA—Neoadjuvant chemotherapy for older patients with ovarian cancer would save $19 million annually compared with primary debulking surgery, based on a new cost- model assessment.
Per-patient costs were 7.5% lower with neoadjuvant chemotherapy, resulting in a difference of $3048 versus surgery. The savings could range as high as $10,000 per patient, given the variation in charge to cost for drug-related group (DRG) codes, reported Michelle R. Rowland, MD, PhD, MPH, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh Medical Center, PA, at the 2013 Society of Gynecologic Oncology annual meeting.
Most of the savings resulted from reduced hospital costs that are primarily attributable to lower projected complication rates in patients who received chemotherapy.
Extrapolating the findings to clinical experience in 2012, “approximately 6350 women age 65 and older will be diagnosed with advanced epithelial ovarian cancer, for an estimated cost-savings of $19 million with neoadjuvant chemotherapy,” Dr Row-land noted.
“Cost-savings may be underestimated, as costs of complications are conservative and readmissions are not included in this model. Moreover, assumptions regarding survival may also affect the cost benefit,” sheexplained.
Results of several studies have suggested that neoadjuvant chemotherapy and primary debulking surgery lead to similar outcomes as initial treatment for older patients with advanced epithelial ovarian cancer. Other studies have indicated higher complication rates and lower chemotherapy completion rates for surgically treated patients.
Noting a lack of consensus about the optimal initial therapy for older patients with ovarian cancer, the investigators performed a cost model comparison of primary debulking surgery and neoadjuvant chemotherapy. The comparison incorporated 2 base treatment strategies:
Costs for debulking surgery and add-on procedures, such as bowel resection, were based on Medicare reimbursement rates. The model took into account the differences in surgical complexity in the 2 treatment arms.
In each treatment arm, the hospital costs were derived from a weighted average of the DRG costs for ovarian cancer, including surgery with no, minor, or major complications, as determined by published data on complication rates of patients aged ≥65 years. The cost of chemotherapy was based on institutional costs, and investigators assumed that 5.7% of patients who were treated with primary debulking surgery would not receive chemotherapy and that 9.5% of the neoadjuvant chemotherapy group would not complete therapy.
The model incorporated the estimated complication rates for both treatment strategies, including complication-free rates of 23.7% with primary surgery and of 35.4% with neoadjuvant chemotherapy.
Both strategies were associated with 1 or more minor complications in 25% of patients, and 1 or more major complications were estimated for 51.3% of surgical patients and for 39.4% of the neoadjuvant chemotherapy arm.
The analysis yielded estimated mean costs of $40,498 per patient for primary debulking surgery and $37,450 for neoadjuvant chemotherapy, including the following component costs:
Estimating that 6350 American women aged ≥65 years have newly diagnosed advanced epithelial ovarian cancer annually, the investigators found a potential cost-savings of $19 million with an initial strategy of neoadjuvant chemotherapy. “Given an average reported charge-to-cost ratio for the DRG codes included of 3.3, the overall estimated charge savings per patient would be $10,058,” they noted. “The cost-savings conclusion is robust to variation in the model parameter estimates.”
A study published last year underscored the complexities involved in assessing cost-effectiveness of therapies for advanced ovarian cancer, said Robert E. Bristow, MD, MBA, Director, Division of Gynecologic Oncology, the University of California, Irvine Medical Center.
This model, which “resulted in a cost- savings of $19 million with neoadjuvant chemotherapy would translate to a cost for primary debulking surgery of only $2800 per quality-adjusted life-year saved,” said Dr Bristow. “Most authorities agree that any treatment that leads to a quality-adjusted life-year cost of less than $75,000 is a good healthcare value.”
