Cost-effectiveness of pulmonary resection and systemic chemotherapy in the management of metastatic soft tissue sarcoma: A combined analysis from the University of Texas M. D. Anderson and Memorial Sloan-Kettering Cancer Centers Journal Article
| Authors: | Porter, G. A.; Cantor, S. B.; Walsh, G. L.; Rusch, V. W.; Leung, D. H.; DeJesus, A. Y.; Pollock, R. E.; Brennan, M. F.; Pisters, P. W. T. |
| Article Title: | Cost-effectiveness of pulmonary resection and systemic chemotherapy in the management of metastatic soft tissue sarcoma: A combined analysis from the University of Texas M. D. Anderson and Memorial Sloan-Kettering Cancer Centers |
| Abstract: | Background: We sought to determine the cost-effectiveness of different treatment strategies for patients with pulmonary metastases from soft tissue sarcoma. Methods: We constructed a decision tree to model the outcomes of 4 treatment strategies for patients with pulmonary metastases from soft tissue sarcoma: pulmonary resection, systemic chemotherapy, pulmonary resection and systemic chemotherapy, and no treatment. Data from 1124 patients with pulmonary metastases from soft tissue sarcoma were used to estimate disease-specific survival for pulmonary resection and no treatment. Outcomes of systemic chemotherapy and pulmonary resection and of systemic chemotherapy were estimated by assuming a 12-month improvement in disease-specific survival with chemotherapy; this was done on the basis of the widely held but unproven assumption that chemotherapy provides a survival benefit in patients with metastatic soft tissue sarcoma. Direct costs were examined for a series of patients who underwent protocol-based pulmonary resection or doxorubicin/ifosfamide-based chemotherapy. Results: The mean cost of pulmonary resection was $20,339 per patient; the mean cost of 6 cycles of chemotherapy was $99,033. Compared with no treatment and assuming a 12-month survival advantage with chemotherapy, the incremental cost-effectiveness ratio was $14,357 per life-year gained for pulmonary resection, $104,210 per life-year gained for systemic chemotherapy, and $51,159 per life-year gained for pulmonary resection and systemic chemotherapy. Compared with pulmonary resection, the incremental cost-effectiveness ratio of pulmonary resection and systemic chemotherapy was $108,036 per life-year gained. Sensitivity analyses showed that certain patient and tumor features, as well as the assumed benefit of chemotherapy, affected cost-effectiveness. Conclusions: For patients with pulmonary metastases from soft tissue sarcoma who were surgical candidates, pulmonary resection was the most cost-effective treatment strategy evaluated. Even with favorable assumptions regarding its clinical benefit, systemic chemotherapy alone, compared with no treatment, was not a cost-effective treatment strategy for these patients. |
| Keywords: | adult; cancer survival; treatment outcome; survival rate; major clinical study; doxorubicin; cancer combination chemotherapy; risk benefit analysis; antineoplastic agents; united states; combined modality therapy; antineoplastic agent; sensitivity analysis; lung resection; lung neoplasms; pneumonectomy; practice guideline; ifosfamide; sarcoma; cost effectiveness analysis; health care cost; lung metastasis; soft tissue sarcoma; intermethod comparison; university hospital; cost-benefit analysis; decision trees; costs and cost analysis; decision support techniques; humans; human; priority journal; article |
| Journal Title: | Journal of Thoracic and Cardiovascular Surgery |
| Volume: | 127 |
| Issue: | 5 |
| ISSN: | 0022-5223 |
| Publisher: | Mosby Elsevier |
| Date Published: | 2004-05-01 |
| Start Page: | 1366 |
| End Page: | 1372 |
| Language: | English |
| DOI: | 10.1016/j.jtcvs.2003.11.016 |
| PROVIDER: | scopus |
| PUBMED: | 15115994 |
| DOI/URL: | |
| Notes: | J. Thorac. Cardiovasc. Surg. -- Cited By (since 1996):24 -- Export Date: 16 June 2014 -- CODEN: JTCSA -- Source: Scopus |
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