Is centralization of ovarian cancer care warranted?

Greving, Jacoba P.; Vernooij, Flora; Heintz, A. Peter M.; Graaf, Yolanda van der; Buskens, Erik

doi:10.1016/j.ygyno.2008.12.008

Cited by 29 publications

(22 citation statements)

References 14 publications

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“…For example, using community-level data from the Mayo clinic, Aletti et al [61] showed that an aggressive and complex surgical approach has a cost-effectiveness ratio of $8912 per lifeyear gained compared with simple surgery in advanced ovarian cancer [61]. Similarly, Bristow et al [62] and Greving et al [63] have valued the place of varying treatment referral centers (e.g., expert center or tertiary referral care) in advanced-stage disease, while Lowery et al [64] demonstrate the potential of early palliative care intervention for recurrent disease cases.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Neoadjuvant Chemotherapy versus Primary Surgery in Elderly Patients with Advanced Ovarian Cancer

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Neoadjuvant Chemotherapy versus Primary Surgery in Elderly Patients with Advanced Ovarian Cancer

et al. 2015

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“…Hess et al The remaining nine included studies 88,97,101,104,105,129,130,132,134 were not the primary source of utility data. For example, four studies 88,97,101,134 referenced (either directly or indirectly) Grann et al,122 although it is unclear how Greving et al 134 used the data in Grann et al 122 to estimate the utility values stated within the study.…”

Section: Ta284mentioning

confidence: 99%

Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for advanced recurrent or refractory ovarian cancer: a systematic review and economic evaluation

Edwards¹,

Barton²,

Thurgar³

et al. 2015

Health Technology Assessment

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BackgroundOvarian cancer is the fifth most common cancer in the UK, and the fourth most common cause of cancer death. Of those people successfully treated with first-line chemotherapy, 55–75% will relapse within 2 years. At this time, it is uncertain which chemotherapy regimen is more clinically effective and cost-effective for the treatment of recurrent, advanced ovarian cancer.ObjectivesTo determine the comparative clinical effectiveness and cost-effectiveness of topotecan (Hycamtin®, GlaxoSmithKline), pegylated liposomal doxorubicin hydrochloride (PLDH; Caelyx®, Schering-Plough), paclitaxel (Taxol®, Bristol-Myers Squibb), trabectedin (Yondelis®, PharmaMar) and gemcitabine (Gemzar®, Eli Lilly and Company) for the treatment of advanced, recurrent ovarian cancer.Data sourcesElectronic databases (MEDLINE®, EMBASE, Cochrane Central Register of Controlled Trials, Health Technology Assessment database, NHS Economic Evaluations Database) and trial registries were searched, and company submissions were reviewed. Databases were searched from inception to May 2013.MethodsA systematic review of the clinical and economic literature was carried out following standard methodological principles. Double-blind, randomised, placebo-controlled trials, evaluating topotecan, PLDH, paclitaxel, trabectedin and gemcitabine, and economic evaluations were included. A network meta-analysis (NMA) was carried out. A de novo economic model was developed.ResultsFor most outcomes measuring clinical response, two networks were constructed: one evaluating platinum-based regimens and one evaluating non-platinum-based regimens. In people with platinum-sensitive disease, NMA found statistically significant benefits for PLDH plus platinum, and paclitaxel plus platinum for overall survival (OS) compared with platinum monotherapy. PLDH plus platinum significantly prolonged progression-free survival (PFS) compared with paclitaxel plus platinum. Of the non-platinum-based treatments, PLDH monotherapy and trabectedin plus PLDH were found to significantly increase OS, but not PFS, compared with topotecan monotherapy. In people with platinum-resistant/-refractory (PRR) disease, NMA found no statistically significant differences for any treatment compared with alternative regimens in OS and PFS. Economic modelling indicated that, for people with platinum-sensitive disease and receiving platinum-based therapy, the estimated probabilistic incremental cost-effectiveness ratio [ICER; incremental cost per additional quality-adjusted life-year (QALY)] for paclitaxel plus platinum compared with platinum was £24,539. Gemcitabine plus carboplatin was extendedly dominated, and PLDH plus platinum was strictly dominated. For people with platinum-sensitive disease and receiving non-platinum-based therapy, the probabilistic ICERs associated with PLDH compared with paclitaxel, and trabectedin plus PLDH compared with PLDH, were estimated to be £25,931 and £81,353, respectively. Topotecan was strictly dominated. For people with PRR disease, the probabilistic ICER associated with topotecan compared with PLDH was estimated to be £324,188. Paclitaxel was strictly dominated.LimitationsAs platinum- and non-platinum-based treatments were evaluated separately, the comparative clinical effectiveness and cost-effectiveness of these regimens is uncertain in patients with platinum-sensitive disease.ConclusionsFor platinum-sensitive disease, it was not possible to compare the clinical effectiveness and cost-effectiveness of platinum-based therapies with non-platinum-based therapies. For people with platinum-sensitive disease and treated with platinum-based therapies, paclitaxel plus platinum could be considered cost-effective compared with platinum at a threshold of £30,000 per additional QALY. For people with platinum-sensitive disease and treated with non-platinum-based therapies, it is unclear whether PLDH would be considered cost-effective compared with paclitaxel at a threshold of £30,000 per additional QALY; trabectedin plus PLDH is unlikely to be considered cost-effective compared with PLDH. For patients with PRR disease, it is unlikely that topotecan would be considered cost-effective compared with PLDH. Randomised controlled trials comparing platinum with non-platinum-based treatments might help to verify the comparative effectiveness of these regimens.Study registrationThis study is registered as PROSPERO CRD42013003555.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…They found that while the overall upfront cost per patient may be higher at expert centers, that strategy proved more cost-effective in the long run because of the increased quality-adjusted life years [30]. Two years later, Greving et al performed a similar study in the Netherlands [31]. They, however, created a decision analysis model based on actual patient data of 879 patients from a random sample of 18 Dutch hospitals where they were able to collect the specific costs of surgery, inpatient stay, and chemotherapy [31].…”

Section: Benefits Of High Volume/high Provider Carementioning

confidence: 99%

Is It Time to Centralize Ovarian Cancer Care in the United States?

et al. 2015

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Purpose The purpose of this article is to broadly review the most up-to-date information pertaining to the centralization of ovarian cancer care in the United States and worldwide. Methods Much of the present literature pertaining to disparities in and centralization of ovarian cancer care in the United States and internationally was reviewed and included, specifically, original research and review articles. Results Data show improved optimal debulking rates, NCCN guideline adherence, and overall survival rates in higher volume, more specialized hospitals and amongst higher volume providers. Conclusion Patients with invasive epithelial ovarian cancer, especially those with higher stages (III and IV), are better served by centralized care in high-volume hospitals, by high-volume physicians, who adhere to NCCN guidelines wherever possible. More research is needed to determine the policy changes that can increase NCCN guideline adherence in low-volume hospitals and in low-provider caseload scenarios. Policy and future research should be aimed at increasing patient access, either directly or indirectly, to high-volume hospital and high-volume providers, especially amongst Medicare, lower socioeconomic status, and minority patients.

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Is centralization of ovarian cancer care warranted?

Cited by 29 publications

References 14 publications

Cost-Effectiveness of Neoadjuvant Chemotherapy versus Primary Surgery in Elderly Patients with Advanced Ovarian Cancer

Cost-Effectiveness of Neoadjuvant Chemotherapy versus Primary Surgery in Elderly Patients with Advanced Ovarian Cancer

Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for advanced recurrent or refractory ovarian cancer: a systematic review and economic evaluation

Is It Time to Centralize Ovarian Cancer Care in the United States?

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