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Cost-effectiveness of para-aortic lymphadenectomy before chemoradiotherapy in locally advanced cervical cancer

 Jung-Yun Lee  ;  Younhee Kim  ;  Tae-Jin Lee  ;  Yong Woo Jeon  ;  Kidong Kim  ;  Hyun Hoon Chung  ;  Hak Jae Kim  ;  Sang Min Park  ;  Jae-Weon Kim 
 JOURNAL OF GYNECOLOGIC ONCOLOGY, Vol.26(3) : 171-178, 2015 
Journal Title
Issue Date
Chemoradiotherapy/economics* ; Combined Modality Therapy/economics ; Cost-Benefit Analysis ; Female ; Humans ; Laparoscopy/economics ; Lymph Node Excision/economics* ; Lymph Node Excision/methods ; Lymphatic Metastasis ; Markov Chains ; Multimodal Imaging/economics ; Neoplasm Staging ; Positron-Emission Tomography/economics ; Quality of Life ; Quality-Adjusted Life Years ; Tomography, X-Ray Computed/economics ; Uterine Cervical Neoplasms/economics* ; Uterine Cervical Neoplasms/therapy
Chemoradiotherapy ; Cost-Benefit Analysis ; Postoperative Complications ; Quality-Adjusted Life Years ; Uterine Cervical Neoplasms
OBJECTIVE: To evaluate the cost-effectiveness of nodal staging surgery before chemoradiotherapy (CRT) for locally advanced cervical cancer in the era of positron emission tomography/computed tomography (PET/CT). METHODS: A modified Markov model was constructed to evaluate the cost-effectiveness of para-aortic staging surgery before definite CRT when no uptake is recorded in the para-aortic lymph nodes (PALN) on PET/CT. Survival and complication rates were estimated based on the published literature. Cost data were obtained from the Korean Health Insurance Review and Assessment Service. Strategies were compared using an incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed, including estimates for the performance of PET/CT, postoperative complication rate, and varying survival rates according to the radiation field. RESULTS: We compared two strategies: strategy 1, pelvic CRT for all patients; and strategy 2, nodal staging surgery followed by extended-field CRT when PALN metastasis was found and pelvic CRT otherwise. The ICER for strategy 2 compared to strategy 1 was $19,505 per quality-adjusted life year (QALY). Under deterministic sensitivity analyses, the model was relatively sensitive to survival reduction in patients who undergo pelvic CRT alone despite having occult PALN metastasis. A probabilistic sensitivity analysis demonstrated the robustness of the case results, with a 91% probability of cost-effectiveness at the willingness-to-pay thresholds of $60,000/QALY. CONCLUSION: Nodal staging surgery before definite CRT may be cost-effective when PET/CT imaging shows no evidence of PALN metastasis. Prospective trials are warranted to transfer these results to guidelines.
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1. College of Medicine (의과대학) > Dept. of Obstetrics and Gynecology (산부인과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Jung-Yun(이정윤) ORCID logo https://orcid.org/0000-0001-7948-1350
Jeon, Yongwoo(전용우) ORCID logo https://orcid.org/0000-0002-0659-4159
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