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

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. KenterPatrick M. M. Bossuyt, Ben Willem Mol, Marrije R. Buist^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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 >1 cm 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 (sic) 1400 per intervention, making the overall costs of both strategies comparable (difference (sic) - 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. (C) 2017 Elsevier Inc. All rights reserved.

Original language	English
Pages (from-to)	449-456
Number of pages	8
Journal	Gynecologic Oncology
Volume	146
Issue number	3
DOIs	https://doi.org/10.1016/j.ygyno.2017.06.019
Publication status	Published - Sept 2017

Keywords

Cost-effectiveness
Ovarian cancer
Diagnostic laparoscopy
Cytoreductive surgery
Quality of life
PRIMARY DEBULKING SURGERY
QUALITY-OF-LIFE
NEOADJUVANT CHEMOTHERAPY
PHASE-III
TRIALS
ONCOLOGY
PREDICTION

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10.1016/j.ygyno.2017.06.019

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van de Vrie, R., van Meurs, H. S., Rutten, M. J., Naaktgeboren, C. A., Opmeer, B. C., Gaarenstroom, K. N., van Gorp, T., Ter Brugge, H. G., Hofhuis, W., Schreuder, H. W. R., Arts, H. J. G., Zusterzeel, P. L. M., Pijnenborg, J. M. A., van Haaften, M., Engelen, M. J. A., Boss, E. A., Vos, M. C., Gerestein, K. G., Schutter, E. M. J., ... Buist, M. R. (2017). Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer. Gynecologic Oncology, 146(3), 449-456. https://doi.org/10.1016/j.ygyno.2017.06.019

@article{5d387e310601407892095da4657c276e,

title = "Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer",

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 >1 cm 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 (sic) 1400 per intervention, making the overall costs of both strategies comparable (difference (sic) - 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. (C) 2017 Elsevier Inc. All rights reserved.",

keywords = "Cost-effectiveness, Ovarian cancer, Diagnostic laparoscopy, Cytoreductive surgery, Quality of life, PRIMARY DEBULKING SURGERY, QUALITY-OF-LIFE, NEOADJUVANT CHEMOTHERAPY, PHASE-III, TRIALS, ONCOLOGY, PREDICTION",

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

year = "2017",

month = sep,

doi = "10.1016/j.ygyno.2017.06.019",

language = "English",

volume = "146",

pages = "449--456",

journal = "Gynecologic Oncology",

issn = "0090-8258",

publisher = "Elsevier Science",

number = "3",

}

van de Vrie, R, van Meurs, HS, Rutten, MJ, Naaktgeboren, CA, Opmeer, BC, Gaarenstroom, KN, van Gorp, T, Ter Brugge, HG, Hofhuis, W, Schreuder, HWR, Arts, HJG, Zusterzeel, PLM, Pijnenborg, JMA, van Haaften, M, Engelen, MJA, Boss, EA, Vos, MC, Gerestein, KG, Schutter, EMJ, Kenter, GG, Bossuyt, PMM, Mol, BW & Buist, MR 2017, 'Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer', Gynecologic Oncology, vol. 146, no. 3, pp. 449-456. https://doi.org/10.1016/j.ygyno.2017.06.019

TY - JOUR

T1 - Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer

AU - van de Vrie, Roelien

AU - van Meurs, Hannah S.

AU - Rutten, Marianne J.

AU - Naaktgeboren, Christiana A.

AU - Opmeer, Brent C.

AU - Gaarenstroom, Katja N.

AU - van Gorp, Toon

AU - Ter Brugge, Henk G.

AU - Hofhuis, Ward

AU - Schreuder, Henk W. R.

AU - Arts, Henriette J. G.

AU - Zusterzeel, Petra L. M.

AU - Pijnenborg, Johanna M. A.

AU - van Haaften, Maarten

AU - Engelen, Mirjam J. A.

AU - Boss, Erik A.

AU - Vos, M. Caroline

AU - Gerestein, Kees G.

AU - Schutter, Eltjo M. J.

AU - Kenter, Gemma G.

AU - Bossuyt, Patrick M. M.

AU - Mol, Ben Willem

AU - Buist, Marrije R.

PY - 2017/9

Y1 - 2017/9

N2 - Objective. To evaluate the cost-effectiveness of a diagnostic laparoscopy prior to primary cytoreductive surgery to prevent futile primary cytoreductive surgery (i.e. leaving >1 cm 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 (sic) 1400 per intervention, making the overall costs of both strategies comparable (difference (sic) - 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. (C) 2017 Elsevier Inc. All rights reserved.

AB - Objective. To evaluate the cost-effectiveness of a diagnostic laparoscopy prior to primary cytoreductive surgery to prevent futile primary cytoreductive surgery (i.e. leaving >1 cm 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 (sic) 1400 per intervention, making the overall costs of both strategies comparable (difference (sic) - 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. (C) 2017 Elsevier Inc. All rights reserved.

KW - Cost-effectiveness

KW - Ovarian cancer

KW - Diagnostic laparoscopy

KW - Cytoreductive surgery

KW - Quality of life

KW - PRIMARY DEBULKING SURGERY

KW - QUALITY-OF-LIFE

KW - NEOADJUVANT CHEMOTHERAPY

KW - PHASE-III

KW - TRIALS

KW - ONCOLOGY

KW - PREDICTION

U2 - 10.1016/j.ygyno.2017.06.019

DO - 10.1016/j.ygyno.2017.06.019

M3 - Article

C2 - 28645428

SN - 0090-8258

VL - 146

SP - 449

EP - 456

JO - Gynecologic Oncology

JF - Gynecologic Oncology

IS - 3

ER -