A Cost-Effectiveness Analysis of Neoadjuvant Therapy for Neuroendocrine Cervical Tumors

Abstract

Purpose. This study aimed to assess the cost-effectiveness of neoadjuvant therapy in combination with surgery and adjuvant therapy compared with either surgery alone or surgery plus adjuvant therapy for the treatment of neuroendocrine cervical tumors (NETs). Materials and methods. A single-institution retrospective analysis of 107 patients with NETs was performed based on the new International Federation of Gynecology and Obstetrics (FIGO 2018) staging system. We divided the patients who underwent radical surgery into two groups: neoadjuvant therapy (NACT) and non-neoadjuvant therapy (non-NACT) groups. We performed subgroup analysis of overall survival and cost-effectiveness by dividing the patients with stage I-IV disease into four subgroups. An assessment was constructed to reflect the costs and effectiveness of the treatment from the perspectives of both clinical practice and health economics.Results. The NACT group had -0.45 life-years (LYs) at an incremental cost of $15197.58, compared with the non-NACT group, which means that it is not cost-effective. However, subgroup analysis of patients with stage II disease showed that the NACT group had significantly better overall survival time than the non-NACT group (median overall survival had not been reached versus 29.23 months, p＜0.001). The NACT group had an incremental cost-effectiveness ratio (ICER) of $5921.43/LY compared with the non-NACT group for stage II disease. Probabilistic sensitivity analyses showed that when the willingness-to-pay (WTP) threshold reached $31118.29/LY, which is nearly three times China's per capita GDP 2020, the probability of NACT being cost-effective was 97% versus non-NACT group in the treatment of stage II neuroendocrine tumors of the uterine cervix. Conclusion. NACT is not a cost-effective treatment strategy compared with non-NACT in the treatment of NETs, but may be a cost-effective treatment option for stage II NETs.

Efficacy, safety, and cost-effectiveness analysis of Cerebrolysin in acute ischemic stroke: A rapid health technology assessment

“…After layer-by-layer screening according to the inclusion and exclusion criteria, a final set of 14 articles was included, including 8 SR or meta-analysis [15][16][17][18][19][20][21][22] and 6 pharmacoeconomic studies. [25][26][27][28][29][30] No HTA report was retrieved. The literature screening process and results are provided in Figure 1.…”

“…The research findings from Men et al [28] and He et al [29] both support that, compared to conventional treatment alone, the incremental cost-effectiveness ratio (△C/△E) is lower with the combination of Cerebrolysin injection. The study by Lin et al [25] suggested that in terms of significant efficacy and reasonable cost, Cerebrolysin was the preferred option compared with citicoline. Furthermore, Table 4 Quality evaluation of included pharmacoeconomic studies.…”

“…Lin et al's study suggests that Lizhusaile is more cost-effective than Bi'aoxing. [25] He et al's research compared the efficacy of 3 brand names -Ningzexin, Shuruitai, and Qu'ao -and found that Ningzexin is the most economically favorable treatment for assisting in AIS. [29] Cerebrolysin demonstrates superior cost-effectiveness The overall clinical efficacy rate Tang, R 2017 [19] 2.85 1.75, 4.63 <.001 Yu, F 2018 [20] 1.22 Wang, Z 2017 [16] 1.03 0.83, 1.28 .77 Bornstein, NM 2017 [17] 0.60 0.56, 0.64 <.0001 0.54 0.49, 0.59 .10 z 0.64 0.57, 0.72 .0001…”

“…Lin WS 2004 [25] Zhang GX 2010 [26] Li G 2013 [27] Men P 2016 [28] He X 2017 [29] Strilciuc S 2023 [30] 1 Conducted (C): The report content adheres to the standard of a specific item on the CHEERS 2022 checklist; Partially conducted (PC): The report content is not comprehensive and partially adheres to the standard of a specific item on the CHEERS 2022 checklist; Not reported (NR): The report content does not comply with the standard of a specific item on the CHEERS 2022 checklist; Not applicable (NA):…”

Neuroendocrine neoplasms: Consensus on a patient care pathway

“…Furthermore, at each stage along the care pathway, cost-efficiency can be maximised through a comprehensive understanding of the patient population, health system capacity and resources, as well as the most appropriate diagnostic tools, treatments and supportive care interventions. There is some evidence of the cost-effectiveness of specific treatments for NENs, 94,95,[131][132][133][134][135][136][137] and cost-efficiency of care pathways for other conditions has been demonstrated. [13][14][15][16][17][18] It is important to note, however, that there is currently insufficient evidence on the costeffectiveness of many types of NEN management.…”