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Cost-Effectiveness Analysis of Cytoreductive Surgery and HIPEC Compared With Systemic Chemotherapy in Isolated Peritoneal Carcinomatosis From Metastatic Colorectal Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Cost-effectiveness evaluations of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal carcinomatosis (PC) from metastatic colorectal cancer (mCRC) in the United States are lacking.

Methods

The authors developed a Markov model to evaluate the cost-effectiveness of CRS/HIPEC compared with systemic chemotherapy for isolated PC from mCRC from a societal perspective in the United States. The systemic treatment regimens consisted of FOLFOX, FOLFIRI, bevacizumab, cetuximab, and pantitumumab. The model inputs including costs, probabilities, survival, progression, and utilities were taken from the literature. The cycle length for the model was 2 weeks, and the time horizon was 7 years. A discount rate of 3% was applied. The model was tested for internal and external validation, and robustness was established with univariate sensitivity and probabilistic sensitivity analyses (PSA). The primary outcomes were total costs, quality-adjusted life-years (QALYs), life-years (LYs), and incremental cost-effectiveness ratio (ICER). A willingness-to-pay (WTP) threshold of $100,000 per QALY was assumed.

Results

The ICER for treatment with CRS/HIPEC compared with systemic chemotherapy was $91,034 per QALY gained ($74,098 per LY gained). The univariate sensitivity analysis showed that the total costs for treatment with CRS/HIPEC had the largest effect on the calculated ICER. The CRS/HIPEC treatment was a cost-effective strategy during the majority of simulations in the PSA. The average ICER for 100,000 simulations in the PSA was $70,807 per QALY gained. The likelihood of CRS/HIPEC being a cost-effective strategy at the WTP threshold was 87%.

Conclusions

The CRS/HIPEC procedure is a cost-effective treatment for isolated PC from mCRC in the United States.

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Authors and Affiliations

  1. Harvard T. H. Chan School of Public Health, Boston, USA

    Trevor D. Hamilton MD, MSc & M. G. Myriam Hunink MD, PhD

  2. Department of Surgery, University of British Columbia, Vancouver, Canada

    Trevor D. Hamilton MD, MSc & Andrea J. MacNeill MD, MSc

  3. Division of Medical Oncology, BC Cancer, Vancouver, Canada

    Howard Lim MD, PhD

  4. Erasmus Medical Center, Rotterdam, Netherlands

    M. G. Myriam Hunink MD, PhD

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  1. Trevor D. Hamilton MD, MSc
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  2. Andrea J. MacNeill MD, MSc
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  3. Howard Lim MD, PhD
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Correspondence to Trevor D. Hamilton MD, MSc.

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10434_2018_7111_MOESM1_ESM.jpg

Fig A1. Markov model output for overall survival from CRS/HIPEC versus systemic chemotherapy (A); published survival results from randomized trial comparing CRS/HIPEC versus systemic chemotherapy28 (B); published survival results from large cohort treated with CRS/HIPEC and systemic chemotherapy7 (C). (JPEG 381 kb)

Fig A2. Cost-effectiveness acceptability curve for varying willingness-to-pay thresholds (JPEG 353 kb)

Fig A3. The expected value of perfect information over a range of willingness-to-pay thresholds (JPEG 330 kb)

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Hamilton, T.D., MacNeill, A.J., Lim, H. et al. Cost-Effectiveness Analysis of Cytoreductive Surgery and HIPEC Compared With Systemic Chemotherapy in Isolated Peritoneal Carcinomatosis From Metastatic Colorectal Cancer. Ann Surg Oncol 26, 1110–1117 (2019). https://doi.org/10.1245/s10434-018-07111-y

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