Cost effectiveness of interval cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in stage III ovarian cancer on the basis of a randomized phase III trial

Simone N. Koole, Christiaan Van Lieshout, Willemien J. Van Driel, Evi Van Schagen, Karolina Sikorska, Jacobien M. Kieffer, Jules H. Schagen van Leeuwen, Henk W.R. Schreuder, Ralph H. Hermans, Ignace H. De Hingh, Jacobus Van Der Velden, Henriette J. Arts, Leon F.A.G. Massuger, Arend G. Aalbers, Victor J. Verwaal, Koen K. Van De Vijver, Neil K. Aaronson, Harm Van Tinteren, Gabe S. Sonke, Wim H. Van Harten & 1 others Valesca P. Retèl

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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.

Original languageEnglish
Pages (from-to)2041-2050
Number of pages10
JournalJournal of clinical oncology
Volume37
Issue number23
Early online date28 Jun 2019
DOIs
Publication statusPublished - 10 Aug 2019

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Ovarian Neoplasms
Cost-Benefit Analysis
Quality-Adjusted Life Years
Drug Therapy
Costs and Cost Analysis
Survival
Health Transition
Recurrence
Health Care Costs
Netherlands
Uncertainty
Delivery of Health Care
Population

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Koole, Simone N. ; Van Lieshout, Christiaan ; Van Driel, Willemien J. ; Van Schagen, Evi ; Sikorska, Karolina ; Kieffer, Jacobien M. ; Schagen van Leeuwen, Jules H. ; Schreuder, Henk W.R. ; Hermans, Ralph H. ; De Hingh, Ignace H. ; Van Der Velden, Jacobus ; Arts, Henriette J. ; Massuger, Leon F.A.G. ; Aalbers, Arend G. ; Verwaal, Victor J. ; Van De Vijver, Koen K. ; Aaronson, Neil K. ; Van Tinteren, Harm ; Sonke, Gabe S. ; Van Harten, Wim H. ; Retèl, Valesca P. / Cost effectiveness of interval cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in stage III ovarian cancer on the basis of a randomized phase III trial. In: Journal of clinical oncology. 2019 ; Vol. 37, No. 23. pp. 2041-2050.
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title = "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.",
author = "Koole, {Simone N.} and {Van Lieshout}, Christiaan and {Van Driel}, {Willemien J.} and {Van Schagen}, Evi and Karolina Sikorska and Kieffer, {Jacobien M.} and {Schagen van Leeuwen}, {Jules H.} and Schreuder, {Henk W.R.} and Hermans, {Ralph H.} and {De Hingh}, {Ignace H.} and {Van Der Velden}, Jacobus and Arts, {Henriette J.} and Massuger, {Leon F.A.G.} and Aalbers, {Arend G.} and Verwaal, {Victor J.} and {Van De Vijver}, {Koen K.} and Aaronson, {Neil K.} and {Van Tinteren}, Harm and Sonke, {Gabe S.} and {Van Harten}, {Wim H.} and Ret{\`e}l, {Valesca P.}",
year = "2019",
month = "8",
day = "10",
doi = "10.1200/JCO.19.00594",
language = "English",
volume = "37",
pages = "2041--2050",
journal = "Journal of clinical oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "23",

}

Koole, SN, Van Lieshout, C, Van Driel, WJ, Van Schagen, E, Sikorska, K, Kieffer, JM, Schagen van Leeuwen, JH, Schreuder, HWR, Hermans, RH, De Hingh, IH, Van Der Velden, J, Arts, HJ, Massuger, LFAG, Aalbers, AG, Verwaal, VJ, Van De Vijver, KK, Aaronson, NK, Van Tinteren, H, Sonke, GS, Van Harten, WH & Retèl, VP 2019, 'Cost effectiveness of interval cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in stage III ovarian cancer on the basis of a randomized phase III trial' Journal of clinical oncology, vol. 37, no. 23, pp. 2041-2050. https://doi.org/10.1200/JCO.19.00594

Cost effectiveness of interval cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in stage III ovarian cancer on the basis of a randomized phase III trial. / Koole, Simone N.; Van Lieshout, Christiaan; Van Driel, Willemien J.; Van Schagen, Evi; Sikorska, Karolina; Kieffer, Jacobien M.; Schagen van Leeuwen, Jules H.; Schreuder, Henk W.R.; Hermans, Ralph H.; De Hingh, Ignace H.; Van Der Velden, Jacobus; Arts, Henriette J.; Massuger, Leon F.A.G.; Aalbers, Arend G.; Verwaal, Victor J.; Van De Vijver, Koen K.; Aaronson, Neil K.; Van Tinteren, Harm; Sonke, Gabe S.; Van Harten, Wim H.; Retèl, Valesca P.

In: Journal of clinical oncology, Vol. 37, No. 23, 10.08.2019, p. 2041-2050.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Cost effectiveness of interval cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in stage III ovarian cancer on the basis of a randomized phase III trial

AU - Koole, Simone N.

AU - Van Lieshout, Christiaan

AU - Van Driel, Willemien J.

AU - Van Schagen, Evi

AU - Sikorska, Karolina

AU - Kieffer, Jacobien M.

AU - Schagen van Leeuwen, Jules H.

AU - Schreuder, Henk W.R.

AU - Hermans, Ralph H.

AU - De Hingh, Ignace H.

AU - Van Der Velden, Jacobus

AU - Arts, Henriette J.

AU - Massuger, Leon F.A.G.

AU - Aalbers, Arend G.

AU - Verwaal, Victor J.

AU - Van De Vijver, Koen K.

AU - Aaronson, Neil K.

AU - Van Tinteren, Harm

AU - Sonke, Gabe S.

AU - Van Harten, Wim H.

AU - Retèl, Valesca P.

PY - 2019/8/10

Y1 - 2019/8/10

N2 - 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.

AB - 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.

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U2 - 10.1200/JCO.19.00594

DO - 10.1200/JCO.19.00594

M3 - Article

VL - 37

SP - 2041

EP - 2050

JO - Journal of clinical oncology

JF - Journal of clinical oncology

SN - 0732-183X

IS - 23

ER -