Treatment in Transplant Eligible Multiple Myeloma Patients in Macedonia: Development of Cost-Effectiveness Analysis

Abstract

IntroductIon: The cervical uteri cancer (CUCa) continues being an economic, social burden. Represents the second most common women's cancer death. In developing countries CUCa presents in loco-regional advanced stages (Ib2-IIB), and it is treated with the NCCN guidelines that recommend concurrent Radiotherapy/ Chemotherapy (pRT/CT) as primary treatment. These is the most effective treatment, with an effectiveness of 57-87% in stage Ib2. These is reduced to 66% in IIB stages. The role for surgery in IB2-IIB is controversial. Asian and some European groups use surgery as primary treatment in those stages, and could be an effective alternative in developing countries. objectIves: Cost-effectiveness model to compare the performance of the pRT/CT, the Total Mesometrial Resection (TMMR) and the current treatment used in a Public-Health Institution. Methods: 167 cases of CACu patients with clinical stages IB2-IIB in a five-year period were studied. Clinical data, costs of attention, treatment and relapses were obtained from medical charts and micro-costing. Effectiveness was calculated from survival free relapse percentage to five years (0.81, 0.76, 0.68, 0.52, 0.56). The costs for pRT/CT and TMMR alternatives were simulated based on costs obtained from de Diario Oficial de la Federación and from the Instituto Mexicano del Seguro Social web sites. For the pRT/CT and the TMMR treatments effectivity rates were obtained from published data (0.7 and 0.9 respectively). The standard of treatment was the pRT/CT against which we compared the TMMR and the current treatment (CuT) used at our institution. All the costs were expressed in USD results: