The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer , neoadjuvant chemotherapy and interval cytoreduction are non-inferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality .
PURPOSE To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer .
Cost-utility comparison of neoadjuvant chemotherapy versus primary debulking surgery for treatment of advanced-stage ovarian cancer in patients 65 years old or older.
OBJECTIVE Treatment for advanced-stage epithelial ovarian cancer ( AEOC ) includes primary debulking surgery ( PDS ) or neoadjuvant chemotherapy ( NACT ) . A r and omized controlled trial comparing these treatments result ed in comparable overall survival ( OS ) . Studies report more complications and lower chemotherapy completion rates in patients 65 years old or older receiving PDS .  We sought to evaluate the cost implication s of NACT relative to PDS in AEOC patients 65 years old or older . STUDY DESIGN A 5 year Markov model was created . Arm 1 modeled PDS followed by 6 cycles of carboplatin and paclitaxel ( CT ) . Arm 2 modeled 3 cycles of CT , followed by interval debulking surgery and then 3 additional cycles of CT . Parameters included OS , surgical complications , probability of treatment initiation , treatment cost , and quality of life ( QOL ) . OS was assumed to be equal based on the findings of the international r and omized control trial . Differences in surgical complexity were accounted for in base surgical cost plus add-on procedure costs weighted by occurrence rates . Hospital cost was a weighted average of diagnosis-related group costs weighted by composite estimates of complication rates . Sensitivity analyses were performed . RESULTS Assuming equal survival , NACT produces a cost savings of $ 5616 . If PDS improved median OS by 1.5 months or longer , PDS would be cost effective ( CE ) at a $ 100,000/ quality -adjusted life-year threshold . If PDS improved OS by 3.2 months or longer , it would be CE at a $ 50,000 threshold . The model was robust to variation in costs and complication rates . Moderate decreases in the QOL with NACT would result in PDS being CE . CONCLUSION A model based on the RCT comparing NACT and PDS showed NACT is a cost-saving treatment compared with PDS for AEOC in patients 65 years old or older . Small increases in OS with PDS or moderate declines in QOL with NACT would result in PDS being CE at the $ 100,000/ quality -adjusted life-year threshold . Our results support further evaluation of the effects of PDS on OS , QOL and complications in AEOC patients 65 years old or older
The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer , neoadjuvant chemotherapy and interval cytoreduction are non-inferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality .
PURPOSE To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer .