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

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 V70,046 (95% credibility interval [CrI], V64,016 to V76,661) for interval CRS compared with V85,791 (95% CrI, V78,766 to V93,935) 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 V28,299/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.

Narrative review of cytoreductive surgery and intraperitoneal chemotherapy for peritoneal metastases in ovarian cancer

“…The incremental costeffectiveness ratio, expressed as euros per quality-adjusted life-year, was below the willingness-to-pay threshold in the Netherlands, indicating interval debulking surgery with HIPEC is cost effective for these patients. These results support the reimbursement of costs for patients treated with interval debulking surgery and HIPEC in countries with similar healthcare systems (19).…”

Hyperthermic intraperitoneal chemotherapy for ovarian cancer: The heat is on

“…The incremental cost-effectiveness ratio amounted to €28,299 per QALY, which is under the willingness-to-pay threshold of €80,000 in the Netherlands. 43 These results lend support for reimbursing the costs of treating these patients with interval CRS and HIPEC in countries with comparable health care systems.…”

Decision-Making Analysis for Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer: A Survey by the Executive Committee of the Peritoneal Surface Oncology Group International (PSOGI)

“…One actual PCI threshold that has been advocated is a maximum of 18 points, and – not surprisingly – the lower the threshold was, the more favorable the oncologic outcome. A recent study found that the addition of HIPEC to CRS does not negatively impact the health-related quality of life [27], and two recent studies showed CRS and HIPEC to be cost-effective in two different countries [28, 29].…”