A cost-effective analysis of adjuvant therapies for the treatment of stage I XXXX .

@entity1204 @entity1 @entity365
OBJECTIVES: Recent surveys have indicated that four alternatives are employed for adjuvant treatment of stage I @entity1204 : observation (OBS), high dose rate @entity365 ( @entity365 ), whole pelvic external beam radiotherapy (EBRT), or a combination of pelvic external beam with @entity365 (COMB). Our goal was to evaluate the cost-effectiveness of these alternatives for management of stage I @entity1204 . METHODS: We designed a decision analysis model comparing the four possible treatments in terms of their utility and cost. We reviewed the existing literature and utilized published data to estimate complication and recurrence rates from each treatment option. We obtained cost data from a chart review of @entity1 treated with each approach at a single institution between 1995 and 2005. RESULTS: OBS yielded the lowest expected cost,  437 million per 100,000 @entity1 . COMB yielded the highest cost, at  2.93 billion per 100,000 @entity1 . @entity365 yielded the highest 5-year quality adjusted survival, 86%. In a population of 100,000 @entity1 , @entity365 would result in an additional 8200 quality adjusted survivors compared to OBS, at a cost of  65,900 per survivor. In contrast, EBRT and COMB result in either fewer survivors and/or greater costs when compared to OBS or @entity365 . CONCLUSION: Routine use of adjuvant EBRT or COMB in the management of surgical stage I @entity1204 is not cost-effective. Compared to OBS, post-operative @entity365 improves survival at a cost of  65,900 per survivor, supporting further investigation of this adjuvant therapy.
