COST-EFFECTIVENESS OF POST-THERAPY PET AND TELEPHONE INTERVIEW IN THE CLINICAL FOLLOW-UP OF PATIENTS TREATED WITH LOCALLY ADVANCED CERVICAL CANCER.

Publisher:
Elsevier
Publication Type:
Journal Article
Citation:
Value in Health, 2014, 17 (7), pp. A736 - A737
Issue Date:
2014-11
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Objectives Our previous research indicated that post-therapy PET scanning may obviate the need for hospital-based follow-up in patients with locally advanced cervical cancer who achieved a complete metabolic response (CMR). In these patients, asymptomatic recurrences were rarely discovered through examination in the clinic. The aim of this research is to evaluate the cost-effectiveness of applying different follow-up strategies in Australia. Methods A decision analytical model was constructed to evaluate cost per quality-adjusted life-year (QALY) and life-years gained (LYG) by comparing two follow-up strategies: 1) Routine hospital-based follow-up and 2) Alternative follow-up involving post-therapy PET and nurse-led telephone interview. A model was built using data from a prospective institutional registry study of 105 consecutive women underwent definitive chemoradiation therapy. Based on published institutional data, it was estimated that patients who had a complete metabolic response identified by PET, would have 5-year overall-survival of 93% and 1.5% recurrence rate, while those without CMR would have a 5-year overall-survival of only 36%.The impact of uncertainty was evaluated using probabilistic sensitivity analysis. Results Costs for Alternative follow-up was estimated to be $25,657 compared with $19,982 for Routine follow-up. Alternative follow-up is not cost-saving; this is because the cost of PET screening and additional treatment performed on those without CMR is more than offset by the cost of intensive hospital-based visits avoided. Preliminary modeling suggest that the Alternative follow-up is likely to be cost-effective compared with Routine follow-up with an ICER of $4,094/QALYs gained, given the survival benefit associated with better targeted salvage therapy and that this result is robust to a range of survival gain estimates and other parameters. Conclusions Performing PET scan to evaluate patient's risk of recurrence is an appealing prospect. This study demonstrated that the alternative follow-up with post-therapy PET is likely to be cost-effective when compared to the current practice.
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