Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer

Roelien van de Vrie, Hannah S. van Meurs, Marianne J. Rutten, Christiana A. Naaktgeboren, Brent C. Opmeer, Katja N. Gaarenstroom, Toon van Gorp, Henk G. Ter Brugge, Ward Hofhuis, Henk W.R. Schreuder, Henriette J.G. Arts, Petra L.M. Zusterzeel, Johanna M.A. Pijnenborg, Maarten van Haaften, Mirjam J.A. Engelen, Erik A. Boss, M. Caroline Vos, Kees G. Gerestein, Eltjo M.J. Schutter, Gemma G. Kenter & 3 others Patrick M.M. Bossuyt, Ben Willem Mol, Marrije R. Buist

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective To evaluate the cost-effectiveness of a diagnostic laparoscopy prior to primary cytoreductive surgery to prevent futile primary cytoreductive surgery (i.e. leaving > 1 cm residual disease) in patients suspected of advanced stage ovarian cancer. Methods An economic analysis was conducted alongside a randomized controlled trial in which patients suspected of advanced stage ovarian cancer who qualified for primary cytoreductive surgery were randomized to either laparoscopy or primary cytoreductive surgery. Direct medical costs from a health care perspective over a 6-month time horizon were analyzed. Health outcomes were expressed in quality-adjusted life-years (QALYs) and utility was based on patient's response to the EQ-5D questionnaires. We primarily focused on direct medical costs based on Dutch standard prices. Results We studied 201 patients, of whom 102 were randomized to laparoscopy and 99 to primary cytoreductive surgery. No significant difference in QALYs (utility = 0.01; 95% CI 0.006 to 0.02) was observed. Laparoscopy reduced the number of futile laparotomies from 39% to 10%, while its costs were € 1400 per intervention, making the overall costs of both strategies comparable (difference € − 80 per patient (95% CI − 470 to 300)). Findings were consistent across various sensitivity analyses. Conclusion In patients with suspected advanced stage ovarian cancer, a diagnostic laparoscopy reduced the number of futile laparotomies, without increasing total direct medical health care costs, or adversely affecting complications or quality of life.

LanguageEnglish
Pages449-456
Number of pages8
JournalGynecologic Oncology
Volume146
Issue number3
DOIs
Publication statusPublished - 1 Sep 2017

Keywords

  • Cost-effectiveness
  • Cytoreductive surgery
  • Diagnostic laparoscopy
  • Ovarian cancer
  • Quality of life

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

Cite this

van de Vrie, R., van Meurs, H. S., Rutten, M. J., Naaktgeboren, C. A., Opmeer, B. C., Gaarenstroom, K. N., ... Buist, M. R. (2017). Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer. Gynecologic Oncology, 146(3), 449-456. https://doi.org/10.1016/j.ygyno.2017.06.019
van de Vrie, Roelien ; van Meurs, Hannah S. ; Rutten, Marianne J. ; Naaktgeboren, Christiana A. ; Opmeer, Brent C. ; Gaarenstroom, Katja N. ; van Gorp, Toon ; Ter Brugge, Henk G. ; Hofhuis, Ward ; Schreuder, Henk W.R. ; Arts, Henriette J.G. ; Zusterzeel, Petra L.M. ; Pijnenborg, Johanna M.A. ; van Haaften, Maarten ; Engelen, Mirjam J.A. ; Boss, Erik A. ; Vos, M. Caroline ; Gerestein, Kees G. ; Schutter, Eltjo M.J. ; Kenter, Gemma G. ; Bossuyt, Patrick M.M. ; Mol, Ben Willem ; Buist, Marrije R. / Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer. In: Gynecologic Oncology. 2017 ; Vol. 146, No. 3. pp. 449-456.
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abstract = "Objective To evaluate the cost-effectiveness of a diagnostic laparoscopy prior to primary cytoreductive surgery to prevent futile primary cytoreductive surgery (i.e. leaving > 1 cm residual disease) in patients suspected of advanced stage ovarian cancer. Methods An economic analysis was conducted alongside a randomized controlled trial in which patients suspected of advanced stage ovarian cancer who qualified for primary cytoreductive surgery were randomized to either laparoscopy or primary cytoreductive surgery. Direct medical costs from a health care perspective over a 6-month time horizon were analyzed. Health outcomes were expressed in quality-adjusted life-years (QALYs) and utility was based on patient's response to the EQ-5D questionnaires. We primarily focused on direct medical costs based on Dutch standard prices. Results We studied 201 patients, of whom 102 were randomized to laparoscopy and 99 to primary cytoreductive surgery. No significant difference in QALYs (utility = 0.01; 95{\%} CI 0.006 to 0.02) was observed. Laparoscopy reduced the number of futile laparotomies from 39{\%} to 10{\%}, while its costs were € 1400 per intervention, making the overall costs of both strategies comparable (difference € − 80 per patient (95{\%} CI − 470 to 300)). Findings were consistent across various sensitivity analyses. Conclusion In patients with suspected advanced stage ovarian cancer, a diagnostic laparoscopy reduced the number of futile laparotomies, without increasing total direct medical health care costs, or adversely affecting complications or quality of life.",
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van de Vrie, R, van Meurs, HS, Rutten, MJ, Naaktgeboren, CA, Opmeer, BC, Gaarenstroom, KN, van Gorp, T, Ter Brugge, HG, Hofhuis, W, Schreuder, HWR, Arts, HJG, Zusterzeel, PLM, Pijnenborg, JMA, van Haaften, M, Engelen, MJA, Boss, EA, Vos, MC, Gerestein, KG, Schutter, EMJ, Kenter, GG, Bossuyt, PMM, Mol, BW & Buist, MR 2017, 'Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer', Gynecologic Oncology, vol. 146, no. 3, pp. 449-456. https://doi.org/10.1016/j.ygyno.2017.06.019

Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer. / van de Vrie, Roelien; van Meurs, Hannah S.; Rutten, Marianne J.; Naaktgeboren, Christiana A.; Opmeer, Brent C.; Gaarenstroom, Katja N.; van Gorp, Toon; Ter Brugge, Henk G.; Hofhuis, Ward; Schreuder, Henk W.R.; Arts, Henriette J.G.; Zusterzeel, Petra L.M.; Pijnenborg, Johanna M.A.; van Haaften, Maarten; Engelen, Mirjam J.A.; Boss, Erik A.; Vos, M. Caroline; Gerestein, Kees G.; Schutter, Eltjo M.J.; Kenter, Gemma G.; Bossuyt, Patrick M.M.; Mol, Ben Willem; Buist, Marrije R.

In: Gynecologic Oncology, Vol. 146, No. 3, 01.09.2017, p. 449-456.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer

AU - van de Vrie, Roelien

AU - van Meurs, Hannah S.

AU - Rutten, Marianne J.

AU - Naaktgeboren, Christiana A.

AU - Opmeer, Brent C.

AU - Gaarenstroom, Katja N.

AU - van Gorp, Toon

AU - Ter Brugge, Henk G.

AU - Hofhuis, Ward

AU - Schreuder, Henk W.R.

AU - Arts, Henriette J.G.

AU - Zusterzeel, Petra L.M.

AU - Pijnenborg, Johanna M.A.

AU - van Haaften, Maarten

AU - Engelen, Mirjam J.A.

AU - Boss, Erik A.

AU - Vos, M. Caroline

AU - Gerestein, Kees G.

AU - Schutter, Eltjo M.J.

AU - Kenter, Gemma G.

AU - Bossuyt, Patrick M.M.

AU - Mol, Ben Willem

AU - Buist, Marrije R.

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Objective To evaluate the cost-effectiveness of a diagnostic laparoscopy prior to primary cytoreductive surgery to prevent futile primary cytoreductive surgery (i.e. leaving > 1 cm residual disease) in patients suspected of advanced stage ovarian cancer. Methods An economic analysis was conducted alongside a randomized controlled trial in which patients suspected of advanced stage ovarian cancer who qualified for primary cytoreductive surgery were randomized to either laparoscopy or primary cytoreductive surgery. Direct medical costs from a health care perspective over a 6-month time horizon were analyzed. Health outcomes were expressed in quality-adjusted life-years (QALYs) and utility was based on patient's response to the EQ-5D questionnaires. We primarily focused on direct medical costs based on Dutch standard prices. Results We studied 201 patients, of whom 102 were randomized to laparoscopy and 99 to primary cytoreductive surgery. No significant difference in QALYs (utility = 0.01; 95% CI 0.006 to 0.02) was observed. Laparoscopy reduced the number of futile laparotomies from 39% to 10%, while its costs were € 1400 per intervention, making the overall costs of both strategies comparable (difference € − 80 per patient (95% CI − 470 to 300)). Findings were consistent across various sensitivity analyses. Conclusion In patients with suspected advanced stage ovarian cancer, a diagnostic laparoscopy reduced the number of futile laparotomies, without increasing total direct medical health care costs, or adversely affecting complications or quality of life.

AB - Objective To evaluate the cost-effectiveness of a diagnostic laparoscopy prior to primary cytoreductive surgery to prevent futile primary cytoreductive surgery (i.e. leaving > 1 cm residual disease) in patients suspected of advanced stage ovarian cancer. Methods An economic analysis was conducted alongside a randomized controlled trial in which patients suspected of advanced stage ovarian cancer who qualified for primary cytoreductive surgery were randomized to either laparoscopy or primary cytoreductive surgery. Direct medical costs from a health care perspective over a 6-month time horizon were analyzed. Health outcomes were expressed in quality-adjusted life-years (QALYs) and utility was based on patient's response to the EQ-5D questionnaires. We primarily focused on direct medical costs based on Dutch standard prices. Results We studied 201 patients, of whom 102 were randomized to laparoscopy and 99 to primary cytoreductive surgery. No significant difference in QALYs (utility = 0.01; 95% CI 0.006 to 0.02) was observed. Laparoscopy reduced the number of futile laparotomies from 39% to 10%, while its costs were € 1400 per intervention, making the overall costs of both strategies comparable (difference € − 80 per patient (95% CI − 470 to 300)). Findings were consistent across various sensitivity analyses. Conclusion In patients with suspected advanced stage ovarian cancer, a diagnostic laparoscopy reduced the number of futile laparotomies, without increasing total direct medical health care costs, or adversely affecting complications or quality of life.

KW - Cost-effectiveness

KW - Cytoreductive surgery

KW - Diagnostic laparoscopy

KW - Ovarian cancer

KW - Quality of life

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van de Vrie R, van Meurs HS, Rutten MJ, Naaktgeboren CA, Opmeer BC, Gaarenstroom KN et al. Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer. Gynecologic Oncology. 2017 Sep 1;146(3):449-456. https://doi.org/10.1016/j.ygyno.2017.06.019