Cost-Effectiveness of Surveillance for Distant Recurrence in Extremity Soft Tissue Sarcoma.
Ann Surg Oncol
; 24(11): 3264-3270, 2017 Oct.
Article
em En
| MEDLINE
| ID: mdl-28718037
ABSTRACT
BACKGROUND:
Optimal distant recurrence (DR) surveillance strategies for extremity soft tissue sarcoma (STS) are unknown. We performed a cost-effectiveness analysis of different imaging modalities performed at guideline-specified intervals.METHODS:
We developed a Markov model simulating lifetime outcomes for 54-year-old patients after definitive treatment for American Joint Committee on Cancer stage II-III extremity STS using four surveillance strategies watchful waiting (WW), chest X-ray (CXR), chest computed tomography (CCT), and positron emission tomography-computed tomography (PET/CT). Probabilities, utilities, and costs were extracted from the literature and Medicare claims to determine incremental cost-effectiveness ratios (ICER).RESULTS:
CCT was the most effective and most costly strategy with CXR the most cost-effective strategy at a societal willing-to-pay (WTP) of $100,000/quality-adjusted life year (QALY). The ICER was $12,113/QALY for CXR versus $104,366/QALY for CCT while PET/CT was never cost-effective. Sensitivity analyses demonstrated CCT becomes the preferred imaging modality as the lifetime risk of DR increases beyond 33% or as the WTP increases beyond $120,000/QALY.CONCLUSIONS:
Optimal DR surveillance imaging for stage II-III extremity STS should be individualized based on patients' risks for DR. These results suggest CXR, or CCT performed at more protracted intervals, may be preferred for lower-risk patients (i.e., DR risk <33%), whereas CCT may be preferred for higher-risk patients (i.e., DR risk >33%). Further study of optimal strategies is needed. In the interim, these findings may help to refine guidelines to reduce resource overutilization during routine surveillance of lower-risk sarcoma patients.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Sarcoma
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Análise Custo-Benefício
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Modelos Econômicos
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Extremidades
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Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada
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Recidiva Local de Neoplasia
Tipo de estudo:
Diagnostic_studies
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Guideline
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Health_economic_evaluation
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Limite:
Adult
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Aged
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Aged80
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Humans
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Middle aged
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article