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BACKGROUND. The objective of this study was to evaluate the cost‐effectiveness of centralized referral of patients with advanced‐stage epithelial ovarian cancer who underwent primary cytoreductive surgery and adjuvant chemotherapy. METHODS. A decision‐analysis model was used to compare 2 referral strategies for patients with advanced‐stage ovarian cancer: 1) referral to an expert center, with a rate of optimal primary cytoreduction of 75% and utilization of combined intraperitoneal and intravenous adjuvant chemotherapy, and 2) referral to a less experienced center, with a rate of optimal primary cytoreduction of 25% and adjuvant treatment that consisted predominantly of intravenous chemotherapy alone. The cost‐effectiveness of each strategy was evaluated from the perspective of society. RESULTS. A cost‐effectiveness analysis revealed that the strategy of expert center referral had an overall cost per patient of $50,652 and had an effectiveness of 5.12 quality‐adjusted life years (QALYs). The strategy of referral to a less experienced center carried an overall cost of $39,957 and had an effectiveness of 2.33 QALYs. The expert center strategy was associated with an additional 2.78 QALYs at an incremental cost of $10,695 but was more cost‐effective, with a cost‐effective ratio of $9893 per QALY compared with $17,149 per QALY for the less experienced center referral strategy. Sensitivity analyses and a Monte Carlo simulation confirmed the robustness of the model. CONCLUSIONS. According to results from the decision‐analysis model, centralized referral of patients with ovarian cancer to an expert center was a cost‐effective healthcare strategy and represents a paradigm for quality cancer care, delivering superior patient outcomes at an economically affordable cost. Increased efforts to align current patterns of care with a universal strategy of centralized expert referral are warranted. Cancer 2007. © 2007 American Cancer Society.

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Standard treatment for advanced epithelial cancer includes primary cytoreductive surgery followed by combination chemotherapy. Optimal primary debulking is associated with improved clinical response rates to primary chemotherapy and longer overall survival. Still, at least 60% of advanced-stage ovarian cancer patients who are without clinical evidence of disease after completing primary therapy ultimately develop recurrent disease. Despite significant efforts, standard treatment of patients with recurrent ovarian cancer remains poorly defined. In view of the new refinement in surgical techniques and medical treatments and the extended disease-free interval, physicians and patients face the dilemma of how to handle further management in this subgroup of patients. A clear understanding of the prognostic factors and expectations from the procedure are necessary in order to identify candidates adequately.